Provider Demographics
NPI:1114449444
Name:DAVID C. MACE, DDS PLLC
Entity Type:Organization
Organization Name:DAVID C. MACE, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-838-2018
Mailing Address - Street 1:1825 S. 324TH PLACE
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8505
Mailing Address - Country:US
Mailing Address - Phone:253-838-2018
Mailing Address - Fax:253-838-9175
Practice Address - Street 1:1825 S. 324TH PLACE
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8505
Practice Address - Country:US
Practice Address - Phone:253-838-2018
Practice Address - Fax:253-838-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00007151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty