Provider Demographics
NPI:1326768409
Name:SOUTH EVERETT ORTHODONTICS LLC
Entity Type:Organization
Organization Name:SOUTH EVERETT ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TENDENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:425-387-6794
Mailing Address - Street 1:18928 43RD DR NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4845
Mailing Address - Country:US
Mailing Address - Phone:425-387-6794
Mailing Address - Fax:
Practice Address - Street 1:10812 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5153
Practice Address - Country:US
Practice Address - Phone:425-338-5414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty