Provider Demographics
NPI:1336488907
Name:HEALTHY SMILES DENTAL AND DENTURE CENTER
Entity Type:Organization
Organization Name:HEALTHY SMILES DENTAL AND DENTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:TANCHOCO
Authorized Official - Last Name:ALCANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-683-0565
Mailing Address - Street 1:220 SW SUNSET BLVD
Mailing Address - Street 2:SUITE C103
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2320
Mailing Address - Country:US
Mailing Address - Phone:425-276-5607
Mailing Address - Fax:425-496-8045
Practice Address - Street 1:220 SW SUNSET BLVD
Practice Address - Street 2:SUITE C103
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2320
Practice Address - Country:US
Practice Address - Phone:425-276-5607
Practice Address - Fax:425-496-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000046261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental