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LILY B. AND SAMUEL D. CROCCO, DMD, PLLC

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Company Details

Legal Name: LILY B. AND SAMUEL D. CROCCO, DMD, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: August 6th 2024
Expiration date: 31 Aug 2026
UBI Number: 605 585 097
ZIP code: 98611
City: Castle Rock
County: COWLITZ
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 358 FRONT AVE NW, CASTLE ROCK, WA, 98611-8996, UNITED STATES
Principal Office Mailing Address: Google Maps Logo PO BOX 487, CASTLE ROCK, WA, 98611-0487, UNITED STATES

Contact Details

E-Mail: SAMUELCROCCODMD@GMAIL.COM
Phone Number: +1 253-377-3536

Nature of Business

Health Care, Social Assistance & Service Organization, DENTISTRY

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Registered Agent Information

Name Role Address
SAMUEL CROCCO Registered Agent 358 FRONT AVE NW, CASTLE ROCK, WA, 98611-8996, UNITED STATES

Key Officers & Management

Name Role Address
LILY B CROCCO, D.M.D. Executor 25642 BERRYHILL RD, EAGLE RIVER, AK, 99577-9603, UNITED STATES
SAMUEL D. CROCCO, D.M.D. Executor 25642 BERRYHILL RD, EAGLE RIVER, AK, 99577-9603, UNITED STATES
LILY B. CROCCO, D.M.D. Governing Person -
SAMUEL D. CROCCO, D.M.D. Governing Person -

National Provider Identifier

NPI Number:
1053143073
Certification Date:
2024-08-14

Authorized Person:

Name:
LILY CROCCO
Role:
OWNER DENTIST
Phone:

Taxonomy:

Selected Taxonomy:
261QD0000X - Dental Clinic/Center
Is Primary:
Yes

Contacts:

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