Provider Demographics
NPI:1881974285
Name:STRAIGHT PEARLS ORTHODONTICS PLLC
Entity type:Organization
Organization Name:STRAIGHT PEARLS ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-802-7100
Mailing Address - Street 1:17000 140TH AVE NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6928
Mailing Address - Country:US
Mailing Address - Phone:425-802-7100
Mailing Address - Fax:425-481-9493
Practice Address - Street 1:6720 FORT DENT WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8508
Practice Address - Country:US
Practice Address - Phone:425-802-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE82071223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty