Provider Demographics
NPI:1568647683
Name:SPECIAL DELIVERY DENTAL CARE, PC
Entity Type:Organization
Organization Name:SPECIAL DELIVERY DENTAL CARE, PC
Other - Org Name:GERIATRIC DENTAL GROUP OF WA STATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:LINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-839-1300
Mailing Address - Street 1:728 S 320TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5255
Mailing Address - Country:US
Mailing Address - Phone:253-839-1300
Mailing Address - Fax:
Practice Address - Street 1:728 S 320TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5255
Practice Address - Country:US
Practice Address - Phone:253-839-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6026763511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty