Provider Demographics
NPI:1265086029
Name:OVERLAKE FAMILY DENTAL
Entity type:Organization
Organization Name:OVERLAKE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-898-6970
Mailing Address - Street 1:20612 88TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6656
Mailing Address - Country:US
Mailing Address - Phone:206-898-6970
Mailing Address - Fax:
Practice Address - Street 1:2020 116TH AVE NE STE 220
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3059
Practice Address - Country:US
Practice Address - Phone:425-453-9999
Practice Address - Fax:425-453-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental