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BIRCH BAY DERMATOLOGY, P.S.

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Company Details

Legal Name: BIRCH BAY DERMATOLOGY, P.S.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: September 4th 2014
Date of Dissolution: February 3rd 2023
Expiration date: 30 Sep 2022
UBI Number: 603 433 047
ZIP code: 98226
City: Bellingham
County: WHATCOM
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 4540 CORDATA PKWY STE 101, BELLINGHAM, WA, 98226-8190, UNITED STATES
Supporting healthcare providers fighting with COVID-19: $31,554

Contact Details

E-Mail: MARK@MTGCPA.COM
Phone Number: +1 818-340-4511

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
DOUG HAGENSEN Registered Agent 4540 CORDATA PKWY STE 101, BELLINGHAM, WA, 98226-8190, UNITED STATES

Key Officers & Management

Name Role
SUSAN KALLAL MD Governing Person

National Provider Identifier

NPI Number:
1255728887

Authorized Person:

Name:
DOUG HAGENSEN
Role:
DIRECTOR OF OPERATIONS
Phone:

Taxonomy:

Selected Taxonomy:
207N00000X - Dermatology Physician
Is Primary:
Yes

Contacts:

Fax:
3607782395
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