Provider Demographics
NPI:1871837732
Name:CASCADE ORTHODONTICS
Entity Type:Organization
Organization Name:CASCADE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:SIMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:206-293-3300
Mailing Address - Street 1:1109 S 348TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7079
Mailing Address - Country:US
Mailing Address - Phone:253-944-1848
Mailing Address - Fax:253-944-1857
Practice Address - Street 1:1109 S 348TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7079
Practice Address - Country:US
Practice Address - Phone:253-944-1848
Practice Address - Fax:253-944-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000106361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603 218 784OtherUNIFIED BUSINESS IDENTIFIER (UBI)