Fall City Dental Clinic Inc

Primary specialty

DentistTaxonomy code 122300000X

License

DE00005563 Issued in WA

Legal business name

FALL CITY DENTAL CLINIC INC

Practice address

33609 Redmond-Fall City Rd
Fall City, WA 98024

Phone

(425) 222-7011

Fax

(425) 222-9574

NPI assigned

Aug 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Greg M Fawcett, DDS

Title

Dentist Owner President

Phone

(425) 222-7011

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gregory Manning Fawcett, D.D.S.

  • General Practice Dentistry
  • Fall City, WA
  • NPI 1578602421
  NPD (past)
• Sabra Serrin Fawcett, D.D.S.

  • General Practice Dentistry
  • Fall City, WA
  • NPI 1043359995
  NPD (past)

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841202009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1029",
            "city": "FALL CITY",
            "state": "WA",
            "postal_code": "98024",
            "telephone_number": "425-222-7011",
            "fax_number": "425-222-9574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33609 REDMOND-FALL CITY RD",
            "city": "FALL CITY",
            "state": "WA",
            "postal_code": "98024",
            "telephone_number": "425-222-7011",
            "fax_number": "425-222-9574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALL CITY DENTAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAWCETT",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST OWNER PRESIDENT",
        "authorized_official_telephone_number": "425-222-7011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00005563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INC",
            "identifier": "674169",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "215712215712",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE INS",
            "identifier": "FA1504",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Leigh Dalgleish
• Louise Christine Gabrielle Derksen, COTA/L
• Drew Senior Services (Visiting Angels Snoqualmie Valley/Maple Valley)
• Eastside Mobility, LLC
• McKayla Fahlenkamp
• Gregory Manning Fawcett, D.D.S.
• Sabra Serrin Fawcett, D.D.S.
• Merritt Elizabeth Glennon, LMHCA
• Eugene Wilbert Goertzen, M.D.
• Rockwell Hammond Jr., DMD

• Dentist in Fall City, WA
• Providers in Fall City, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.