1083168512 NPI number — NORTHWEST SMILE DENTAL AND DENTURE

Table of content: (NPI 1083168512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083168512 NPI number — NORTHWEST SMILE DENTAL AND DENTURE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST SMILE DENTAL AND DENTURE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083168512
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7233 MARTIN WAY E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98516-5534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-489-0991
Provider Business Mailing Address Fax Number:
360-915-6214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7233 MARTIN WAY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98516-5534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-489-0991
Provider Business Practice Location Address Fax Number:
360-915-6214
Provider Enumeration Date:
08/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BEALE
Authorized Official First Name:
YOUNI
Authorized Official Middle Name:
CHO
Authorized Official Title or Position:
DENTURIST
Authorized Official Telephone Number:
360-489-0991

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  604003708 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com