Provider Demographics
NPI:1255093050
Name:DENTAL CARE BURLINGTON WA
Entity type:Organization
Organization Name:DENTAL CARE BURLINGTON WA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:GENNADIAVICH
Authorized Official - Last Name:SKACHKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-755-0057
Mailing Address - Street 1:103 E HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233
Mailing Address - Country:US
Mailing Address - Phone:360-755-0057
Mailing Address - Fax:360-755-9828
Practice Address - Street 1:103 E HAZEL AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233
Practice Address - Country:US
Practice Address - Phone:360-755-0057
Practice Address - Fax:360-755-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty