Provider Demographics
NPI:1104980283
Name:AFFORDABLE DENTAL CARE
Entity type:Organization
Organization Name:AFFORDABLE DENTAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LILLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-630-3500
Mailing Address - Street 1:12826 SE 40TH LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006
Mailing Address - Country:US
Mailing Address - Phone:425-401-5000
Mailing Address - Fax:425-957-9966
Practice Address - Street 1:12826 SE 40TH LN
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-401-5000
Practice Address - Fax:425-957-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty