Provider Demographics
NPI:1376028589
Name:GREEN DENTISTRY
Entity Type:Organization
Organization Name:GREEN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMRITPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-753-1163
Mailing Address - Street 1:23040 PACIFIC HWY S STE 311
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-7268
Mailing Address - Country:US
Mailing Address - Phone:206-878-3111
Mailing Address - Fax:
Practice Address - Street 1:23040 PACIFIC HWY S STE 311
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-7268
Practice Address - Country:US
Practice Address - Phone:206-878-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental