MEDICARE: STRAIGHT PEARLS ORTHODONTICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DE8207	WA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DE8207	WA

General Provider Information

NPI Number	:	1881974285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRAIGHT PEARLS ORTHODONTICS PLLC

Provider Business Mailing Address
First Line	:	17000 140TH AVE NE
Second Line	:	SUITE 204
City	:	WOODINVILLE
State	:	WA
Zip	:	98072-6928
Country	:	US
Telephone Number	:	425-802-7100
Fax Number	:	425-481-9493

Provider Business Practice Location Address
First Line	:	6720 FORT DENT WAY
Second Line	:	SUITE 120
City	:	TUKWILA
State	:	WA
Zip	:	98188-8508
Country	:	US
Telephone Number	:	425-802-7100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MAJED MOAWAD
Credential	:	D.M.D.
Telephone Number	:	425-802-7100

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	08/17/2011

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