Provider Demographics
NPI:1154825321
Name:ABOULHOSN AND VALENTINE PLLC
Entity Type:Organization
Organization Name:ABOULHOSN AND VALENTINE PLLC
Other - Org Name:ICON DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-337-2400
Mailing Address - Street 1:2815 2ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1262
Mailing Address - Country:US
Mailing Address - Phone:425-337-2400
Mailing Address - Fax:425-337-1916
Practice Address - Street 1:2815 2ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1262
Practice Address - Country:US
Practice Address - Phone:425-337-2400
Practice Address - Fax:425-337-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60383042261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental