Provider Demographics
NPI:1851465090
Name:EASTSIDE URGENT CARE DENTISTRY
Entity Type:Organization
Organization Name:EASTSIDE URGENT CARE DENTISTRY
Other - Org Name:EASTSIDE EMERGENCY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERILYN
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-459-9694
Mailing Address - Street 1:220 LILLY RD NE
Mailing Address - Street 2:STE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-459-9694
Mailing Address - Fax:360-459-9657
Practice Address - Street 1:220 LILLY RD NE
Practice Address - Street 2:STE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-459-9694
Practice Address - Fax:360-459-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty