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4520 42nd Ave Sw #24 Seattle WA 98116-4240 | |
| (206) 937-6481 | |
| (206) 937-7043 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4520 42nd Ave Sw, Seattle, Washington |
| Authorized Official Name and Position | Christine M Tweedy (OWNER) |
| Authorized Official Contact | 2069376481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4520 42nd Ave Sw #24 Seattle WA 98116-4240 Ph: (206) 937-6481 | 4520 42nd Ave Sw #24 Seattle WA 98116-4240 Ph: (206) 937-6481 |
| NPI Number | 1104147057 |
|---|---|
| Provider Enumeration Date | 06/15/2010 |
| Last Update Date | 06/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104147057 | NPI | - | NPPES |
| 5031596 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 8359 (Washington) | Primary |
| 1223G0001X | Dentist - General Practice | 8359 (Washington) | Secondary |
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