Provider Demographics
NPI:1629381348
Name:GOOD DENTAL & DENTURES
Entity Type:Organization
Organization Name:GOOD DENTAL & DENTURES
Other - Org Name:EXCEL DENTAL & DENTURES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-774-8590
Mailing Address - Street 1:20015 HIGHWAY 99 STE D
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6073
Mailing Address - Country:US
Mailing Address - Phone:425-774-8590
Mailing Address - Fax:425-774-8509
Practice Address - Street 1:20015 HIGHWAY 99 STE D
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6073
Practice Address - Country:US
Practice Address - Phone:425-774-8590
Practice Address - Fax:425-774-8509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000454122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty