Provider Demographics
NPI:1003061466
Name:SMILE AGAIN DENTISTRY
Entity Type:Organization
Organization Name:SMILE AGAIN DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-945-8255
Mailing Address - Street 1:1035 S 320TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5364
Mailing Address - Country:US
Mailing Address - Phone:253-945-8255
Mailing Address - Fax:
Practice Address - Street 1:1035 S 320TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5364
Practice Address - Country:US
Practice Address - Phone:253-945-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000067681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty