Provider Demographics
NPI:1326211525
Name:NORTHWEST DENTAL HYGIENE
Entity Type:Organization
Organization Name:NORTHWEST DENTAL HYGIENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, BS
Authorized Official - Phone:206-325-4763
Mailing Address - Street 1:1033 36TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4323
Mailing Address - Country:US
Mailing Address - Phone:206-325-4763
Mailing Address - Fax:206-325-4763
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:SUITE 1240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1720
Practice Address - Country:US
Practice Address - Phone:206-325-4763
Practice Address - Fax:206-325-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA 1002124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty