Provider Demographics
NPI:1508945908
Name:PAC DENTAL INC
Entity Type:Organization
Organization Name:PAC DENTAL INC
Other - Org Name:PACIFIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-447-8084
Mailing Address - Street 1:900 S JACKSON ST
Mailing Address - Street 2:214
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3053
Mailing Address - Country:US
Mailing Address - Phone:206-447-8084
Mailing Address - Fax:206-223-0855
Practice Address - Street 1:900 S JACKSON ST
Practice Address - Street 2:214
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3053
Practice Address - Country:US
Practice Address - Phone:206-447-8084
Practice Address - Fax:206-223-0855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE90141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty