Provider Demographics
NPI:1922253723
Name:CLINT T. WORTON, DDS - LYNNWOOD, PS
Entity Type:Organization
Organization Name:CLINT T. WORTON, DDS - LYNNWOOD, PS
Other - Org Name:ALDERWOOD CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-775-5411
Mailing Address - Street 1:19106 33RD AVE W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4712
Mailing Address - Country:US
Mailing Address - Phone:425-775-5411
Mailing Address - Fax:425-771-8321
Practice Address - Street 1:19106 33RD AVE W
Practice Address - Street 2:SUITE 1
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4712
Practice Address - Country:US
Practice Address - Phone:425-775-5411
Practice Address - Fax:425-771-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 8714261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental