Provider Demographics
NPI:1639736119
Name:SOUTHCENTER CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:SOUTHCENTER CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-575-1130
Mailing Address - Street 1:2141 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9183
Mailing Address - Country:US
Mailing Address - Phone:360-676-9222
Mailing Address - Fax:360-676-9223
Practice Address - Street 1:411 STRANDER BLVD STE 303
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2924
Practice Address - Country:US
Practice Address - Phone:206-575-1130
Practice Address - Fax:206-575-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty