Provider Demographics
NPI:1013360502
Name:MARK GERMACK DDS PLLC
Entity Type:Organization
Organization Name:MARK GERMACK DDS PLLC
Other - Org Name:ISSAQUAH CREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:GERMACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-450-1939
Mailing Address - Street 1:720 OLIVE WAY
Mailing Address - Street 2:SUITE 835
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-450-1939
Mailing Address - Fax:
Practice Address - Street 1:720 OLIVE WAY
Practice Address - Street 2:SUITE 835
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-450-1939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010298261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental