Provider Demographics
NPI:1558785030
Name:NORTHSHORE DENTAL
Entity Type:Organization
Organization Name:NORTHSHORE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-486-6511
Mailing Address - Street 1:6502 NE 181ST ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4802
Mailing Address - Country:US
Mailing Address - Phone:425-486-6511
Mailing Address - Fax:425-486-8915
Practice Address - Street 1:6502 NE 181ST ST
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4802
Practice Address - Country:US
Practice Address - Phone:425-486-6511
Practice Address - Fax:425-486-8915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental