Provider Demographics
NPI:1396852554
Name:SMILEQUEST PREVENTIVE ORAL HEALTHCARE
Entity type:Organization
Organization Name:SMILEQUEST PREVENTIVE ORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:T
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MHPA RDH
Authorized Official - Phone:509-349-7420
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:605 W 1ST STREET
Mailing Address - City:WARDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98857
Mailing Address - Country:US
Mailing Address - Phone:509-349-7420
Mailing Address - Fax:509-349-2357
Practice Address - Street 1:605 W 1ST STREET
Practice Address - Street 2:
Practice Address - City:WARDEN
Practice Address - State:WA
Practice Address - Zip Code:98857
Practice Address - Country:US
Practice Address - Phone:509-349-7420
Practice Address - Fax:509-349-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5029244Medicaid