Provider Demographics
NPI:1750313086
Name:SAMMAMISH FAMILY DENTAL
Entity Type:Organization
Organization Name:SAMMAMISH FAMILY DENTAL
Other - Org Name:ROBERT HUMBLE, DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-898-0400
Mailing Address - Street 1:22840 NE 8TH ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7262
Mailing Address - Country:US
Mailing Address - Phone:425-898-0400
Mailing Address - Fax:425-898-1705
Practice Address - Street 1:22840 NE 8TH ST
Practice Address - Street 2:STE. 101
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7262
Practice Address - Country:US
Practice Address - Phone:425-898-0400
Practice Address - Fax:425-898-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA74291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
881621OtherUNITED CONCORDIA