Provider Demographics
NPI:1558752352
Name:FREDERICK J WORRELL DDS PLLC
Entity Type:Organization
Organization Name:FREDERICK J WORRELL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-294-9001
Mailing Address - Street 1:16005 NE 198TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-7016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3625 148TH ST SW
Practice Address - Street 2:SUITE# B101
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-5577
Practice Address - Country:US
Practice Address - Phone:425-773-4909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60238959261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental