Provider Demographics
NPI:1225481682
Name:HARBOUR POINTE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:HARBOUR POINTE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-348-8484
Mailing Address - Street 1:4407 106TH ST SW STE A
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4750
Mailing Address - Country:US
Mailing Address - Phone:425-348-8484
Mailing Address - Fax:425-348-6419
Practice Address - Street 1:4407 106TH ST SW STE A
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4750
Practice Address - Country:US
Practice Address - Phone:425-348-8484
Practice Address - Fax:425-348-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental