Provider Demographics
NPI:1699353599
Name:HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Entity Type:Organization
Organization Name:HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REG. OPS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHORAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-275-3042
Mailing Address - Street 1:3022 78TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2823
Mailing Address - Country:US
Mailing Address - Phone:206-275-3042
Mailing Address - Fax:
Practice Address - Street 1:3022 78TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2823
Practice Address - Country:US
Practice Address - Phone:206-275-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty