Provider Demographics
NPI:1639395122
Name:CLEMENT & TEEL PS CORPORATION
Entity Type:Organization
Organization Name:CLEMENT & TEEL PS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-363-6696
Mailing Address - Street 1:3340 NE 125TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8911
Mailing Address - Country:US
Mailing Address - Phone:206-363-6696
Mailing Address - Fax:206-363-0072
Practice Address - Street 1:3340 NE 125TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8911
Practice Address - Country:US
Practice Address - Phone:206-363-6696
Practice Address - Fax:206-363-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000064401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty