Provider Demographics
NPI:1962729889
Name:PAMELA N SURSELY DDS, PLLC
Entity type:Organization
Organization Name:PAMELA N SURSELY DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA N
Authorized Official - Middle Name:
Authorized Official - Last Name:SURSELY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-985-0442
Mailing Address - Street 1:12911 120TH AVE NE STE F200
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3026
Mailing Address - Country:US
Mailing Address - Phone:425-821-9111
Mailing Address - Fax:425-821-2696
Practice Address - Street 1:12911 120TH AVE NE STE F200
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3026
Practice Address - Country:US
Practice Address - Phone:425-821-9111
Practice Address - Fax:425-821-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60122941261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental