Provider Demographics
NPI:1619357514
Name:KARI D CHELLIS RDH DDS PS
Entity Type:Organization
Organization Name:KARI D CHELLIS RDH DDS PS
Other - Org Name:SMILE SECRETS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-935-5522
Mailing Address - Street 1:4700 42ND AVE SW
Mailing Address - Street 2:STE 555
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4591
Mailing Address - Country:US
Mailing Address - Phone:206-935-5522
Mailing Address - Fax:206-932-4577
Practice Address - Street 1:4700 42ND AVE SW
Practice Address - Street 2:STE 555
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4591
Practice Address - Country:US
Practice Address - Phone:206-935-5522
Practice Address - Fax:206-932-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000068501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty