Provider Demographics
NPI:1568981470
Name:SEA MAR SPECIALTY DENTAL GROUP
Entity Type:Organization
Organization Name:SEA MAR SPECIALTY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOESCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:206-763-5277
Mailing Address - Street 1:1040 S HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4720
Mailing Address - Country:US
Mailing Address - Phone:206-763-5277
Mailing Address - Fax:
Practice Address - Street 1:2000 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3047
Practice Address - Country:US
Practice Address - Phone:425-998-5090
Practice Address - Fax:425-998-5099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEA-MAR COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial SurgeryGroup - Multi-Specialty