Provider Demographics
NPI:1356942684
Name:HEALTHY SMILES NORTHWEST
Entity type:Organization
Organization Name:HEALTHY SMILES NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:541-908-2692
Mailing Address - Street 1:11808 18TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2046
Mailing Address - Country:US
Mailing Address - Phone:541-908-2692
Mailing Address - Fax:
Practice Address - Street 1:11808 18TH ST SE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2046
Practice Address - Country:US
Practice Address - Phone:541-908-2692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental