Provider Demographics
NPI:1689896102
Name:SEATTLE CENTRAL COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:SEATTLE CENTRAL COMMUNITY COLLEGE
Other - Org Name:DENTAL HYGIENE CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:OLLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-587-4144
Mailing Address - Street 1:1701 BROADWAY
Mailing Address - Street 2:BE3210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2413
Mailing Address - Country:US
Mailing Address - Phone:206-587-6922
Mailing Address - Fax:206-587-6337
Practice Address - Street 1:2120 S JACKSON ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2219
Practice Address - Country:US
Practice Address - Phone:206-344-4423
Practice Address - Fax:206-516-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010635261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental