Provider Demographics
NPI:1225795917
Name:SMYLE DENTURE DESIGN
Entity Type:Organization
Organization Name:SMYLE DENTURE DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTURIST
Authorized Official - Prefix:
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOU
Authorized Official - Suffix:
Authorized Official - Credentials:DPD
Authorized Official - Phone:206-419-0969
Mailing Address - Street 1:332 NE 175TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3518
Mailing Address - Country:US
Mailing Address - Phone:206-605-7699
Mailing Address - Fax:
Practice Address - Street 1:7125 224TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8397
Practice Address - Country:US
Practice Address - Phone:206-419-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124519103Medicaid