Provider Demographics
NPI:1437284148
Name:FAMILY DENTAL CARE OF MILL CREEK
Entity Type:Organization
Organization Name:FAMILY DENTAL CARE OF MILL CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-745-9420
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY STE 260
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1274
Mailing Address - Country:US
Mailing Address - Phone:425-745-9420
Mailing Address - Fax:425-338-7062
Practice Address - Street 1:16030 BOTHELL EVERETT HWY STE 260
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1274
Practice Address - Country:US
Practice Address - Phone:425-745-9420
Practice Address - Fax:425-338-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA73241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty