Healthcare Provider Details

I. General information

NPI: 1083433296
Provider Name (Legal Business Name): BOTHELL ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19110 BOTHELL WAY NE STE 101
BOTHELL WA
98011-2970
US

IV. Provider business mailing address

19110 BOTHELL WAY NE STE 101
BOTHELL WA
98011-2970
US

V. Phone/Fax

Practice location:
  • Phone: 425-482-9211
  • Fax:
Mailing address:
  • Phone: 425-482-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE SORIANO
Title or Position: PRESIDENT
Credential: DDS
Phone: 425-482-9211