Provider Demographics
NPI:1710127030
Name:HYODOLEEMAGELSENYI III, PLLC
Entity Type:Organization
Organization Name:HYODOLEEMAGELSENYI III, PLLC
Other - Org Name:LAKEWOOD DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAGELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-652-1400
Mailing Address - Street 1:2704 -171ST PL. NE,
Mailing Address - Street 2:SUITE L-101
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4712
Mailing Address - Country:US
Mailing Address - Phone:360-652-1400
Mailing Address - Fax:360-652-1433
Practice Address - Street 1:2704 -171ST PL. NE,
Practice Address - Street 2:SUITE L-101
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4712
Practice Address - Country:US
Practice Address - Phone:360-652-1400
Practice Address - Fax:360-652-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602870164261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental