Provider Demographics
NPI:1528759677
Name:FME FAMILY DENTAL
Entity type:Organization
Organization Name:FME FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-922-6667
Mailing Address - Street 1:6104 20TH ST E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2025
Mailing Address - Country:US
Mailing Address - Phone:253-922-6667
Mailing Address - Fax:253-926-2241
Practice Address - Street 1:6104 20TH ST E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2025
Practice Address - Country:US
Practice Address - Phone:253-922-6667
Practice Address - Fax:253-922-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental