Provider Demographics
NPI:1497190201
Name:NORTHEAST SEATTLE ORTHODONTICS
Entity Type:Organization
Organization Name:NORTHEAST SEATTLE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:206-524-8020
Mailing Address - Street 1:6850 35TH AVE NE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7344
Mailing Address - Country:US
Mailing Address - Phone:206-524-8020
Mailing Address - Fax:206-524-9028
Practice Address - Street 1:6850 35TH AVE NE
Practice Address - Street 2:SUITE 8
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7344
Practice Address - Country:US
Practice Address - Phone:206-524-8020
Practice Address - Fax:206-524-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA88191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA12OtherDENTIST-ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS
WA1992974836OtherNPI TYPE 1
WA8819OtherDENTAL LICENSE