| Evergreen Pediatric Dentistry | |
|
12910 Totem Lake Blvd Ne Ste 103 Kirkland WA 98034 | |
| (425) 814-3196 | |
| (425) 825-9646 |
| Full Name | Evergreen Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 12910 Totem Lake Blvd Ne Ste 103, Kirkland, Washington |
| Authorized Official Name and Position | Susan S Kim (PRESIDENT) |
| Authorized Official Contact | 4258143196 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Pediatric Dentistry 12910 Totem Lake Blvd Ne Ste 103 Kirkland WA 98034-2901 Ph: (425) 814-3196 | Evergreen Pediatric Dentistry 12910 Totem Lake Blvd Ne Ste 103 Kirkland WA 98034 Ph: (425) 814-3196 |
| NPI Number | 1265495196 |
|---|---|
| Provider Enumeration Date | 04/11/2006 |
| Last Update Date | 07/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265495196 | NPI | - | NPPES |
| 5048368 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 9731 (Washington) | Primary |
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