1801510037 NPI number — DENTAL SMILES OF WASHINGTON, PLC

Table of content: HEIDI BETH KIXMILLER LCSW (NPI 1912288507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801510037 NPI number — DENTAL SMILES OF WASHINGTON, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL SMILES OF WASHINGTON, PLC
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:
DENTAL HOUSE OF WASHINGTON
Provider Other Organization Name Type Code:
3
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:
1801510037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1161 RYAN CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORALVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52241-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 HIGHWAY 1 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52353-9782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-653-4451
Provider Business Practice Location Address Fax Number:
319-653-3392
Provider Enumeration Date:
09/30/2022

Additional Information

Authorized Official

Authorized Official Last Name:
SHARMA
Authorized Official First Name:
SUCHITRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
319-653-4451

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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