Provider Demographics
NPI:1710052527
Name:OJH CLINIC #4 INC
Entity Type:Organization
Organization Name:OJH CLINIC #4 INC
Other - Org Name:SMOKEY POINT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-658-3000
Mailing Address - Street 1:3533 172ND ST NE
Mailing Address - Street 2:BLDG B
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223
Mailing Address - Country:US
Mailing Address - Phone:360-658-3000
Mailing Address - Fax:360-653-1560
Practice Address - Street 1:3533 172ND ST NE
Practice Address - Street 2:BLDG B
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-658-3000
Practice Address - Fax:360-653-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty