Provider Demographics
NPI:1497072698
Name:GNWS INC
Entity Type:Organization
Organization Name:GNWS INC
Other - Org Name:GREAT NORTH WEST SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:UNSICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-981-4001
Mailing Address - Street 1:30775 SW BOONES FERRY RD STE E
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7822
Mailing Address - Country:US
Mailing Address - Phone:503-981-4001
Mailing Address - Fax:
Practice Address - Street 1:30775 SW BOONES FERRY RD STE E
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7822
Practice Address - Country:US
Practice Address - Phone:503-981-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10130778122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty