1982057998 NPI number — SMITA PATEL, DMD PLLC

Table of content: (NPI 1982057998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982057998 NPI number — SMITA PATEL, DMD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITA PATEL, DMD PLLC
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:
SMILES BY SMITA ORTHODONTICS
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:
1982057998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22506 MARINE VIEW DR S
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98198-6906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-249-8880
Provider Business Mailing Address Fax Number:
206-592-2386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22506 MARINE VIEW DR S
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198-6906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-249-8880
Provider Business Practice Location Address Fax Number:
206-592-2386
Provider Enumeration Date:
07/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
SMITA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ORTHODONTIST
Authorized Official Telephone Number:
206-249-8880

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  DE10731 , 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)

  • Identifier: 1467668608 . This is a "TYPE 1 NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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