Provider Demographics
NPI:1598272452
Name:LITTLE PEARLS BOTHELL LLC
Entity Type:Organization
Organization Name:LITTLE PEARLS BOTHELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-263-7116
Mailing Address - Street 1:3704 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1138
Mailing Address - Country:US
Mailing Address - Phone:813-263-7116
Mailing Address - Fax:
Practice Address - Street 1:1908 201ST PL SE APT 201
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8572
Practice Address - Country:US
Practice Address - Phone:425-375-4789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-01
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty