Provider Demographics
NPI:1417935917
Name:MAURINE MACHUGH DDS, PLLC
Entity Type:Organization
Organization Name:MAURINE MACHUGH DDS, PLLC
Other - Org Name:EVERGREENPERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-820-2414
Mailing Address - Street 1:12911 120TH AVE NE
Mailing Address - Street 2:STE F240
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3027
Mailing Address - Country:US
Mailing Address - Phone:425-820-2414
Mailing Address - Fax:425-814-1757
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:STE F240
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-820-2414
Practice Address - Fax:425-814-1757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty