Provider Demographics
NPI:1093028706
Name:CARE DENTAL
Entity Type:Organization
Organization Name:CARE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG-A
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RO-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-347-7722
Mailing Address - Street 1:621 128TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6319
Mailing Address - Country:US
Mailing Address - Phone:425-347-7722
Mailing Address - Fax:425-347-7723
Practice Address - Street 1:621 128TH ST SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6319
Practice Address - Country:US
Practice Address - Phone:425-347-7722
Practice Address - Fax:425-347-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010385261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5051198Medicaid