Charles Fredrick Ebsworth, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4073 Issued in WA

Practice address

17191 Bothell Way NE
Suite 201
Lake Forest Park, WA 98155-5534

Phone

(206) 362-0152

Fax

(206) 365-3441

NPI assigned

Apr 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fred Ebsworth DDS PS

  • Dental Clinic/Center
  • Lake Forest Park, WA
  • NPI 1104061969
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1023071149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17191 BOTHELL WAY NE",
            "address_2": "SUITE 201",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555534",
            "telephone_number": "206-362-0152",
            "fax_number": "206-365-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17191 BOTHELL WAY NE",
            "address_2": "SUITE 201",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555534",
            "telephone_number": "206-362-0152",
            "fax_number": "206-365-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBSWORTH",
        "first_name": "CHARLES",
        "middle_name": "FREDRICK",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "4073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Corey, ARNP
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• Daniel Giovinazzo MD PHD PLLC
• Cheryl S. Decker, MS, RD, CD
• Emily Pearson Easley, ARNP
• Willow Eight
• Thomas L. Fasnacht
• Bethany Field
• Rebecca Foglietti
• Fred Ebsworth DDS PS

• General Practice Dentistry in Lake Forest Park, WA
• Providers in Lake Forest Park, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.