NPIMap

Organization Active NPI

House, Lee, Mast, McDonald and Nelson, PC

Doing business as Eastside Pediatric Dental Group

  • Pediatric Dentistry
  • Issaquah, WA
National Provider Identifier
1831423292
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
6912 Issued in WA
Legal business name
HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Doing business as
Eastside Pediatric Dental Group
Practice address
185 NE Gilman Blvd
Issaquah, WA 98027-2937
Phone
(425) 392-4048
Fax
(425) 557-1138
NPI assigned
Oct 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Authorized official

Name
Lanette McIntosh, AO
Title
Regional Operations Manager
Phone
(425) 396-1011

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 6912 WA Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 6870 WA
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 8235 WA

Addresses

Primary practice location

185 NE Gilman Blvd
Issaquah, WA 98027-2937

Mailing address

185 NE Gilman Blvd
Issaquah, WA 98027-2937
Phone (425) 392-4048

Other identifiers 1

IdentifierTypeStateIssuer
5017967MedicaidWA

Other names 1

  • Eastside Pediatric Dental Group Doing business as

National Provider Directory

National Provider Directory

Locations

185 NE Gilman Blvd
Issaquah, WA 98027
Phone (425) 392-4048

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1254355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614211200000",
    "number": "1831423292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 NE GILMAN BLVD",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272937",
            "telephone_number": "425-392-4048",
            "fax_number": "425-557-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 NE GILMAN BLVD",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272937",
            "telephone_number": "425-392-4048",
            "fax_number": "425-557-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOUSE, LEE, MAST, MCDONALD AND NELSON, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-01",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A",
        "authorized_official_last_name": "MCINTOSH",
        "authorized_official_first_name": "LANETTE",
        "authorized_official_title_or_position": "REGIONAL OPERATIONS MANAGER",
        "authorized_official_telephone_number": "425-396-1011",
        "authorized_official_credential": "AO"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "6912",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "6870",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "8235",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5017967",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Pediatric Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; 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.