Healthcare Provider Details

I. General information

NPI: 1831047844
Provider Name (Legal Business Name): NAGATOMO DDS PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18323 98TH AVE NE STE 4
BOTHELL WA
98011-3358
US

IV. Provider business mailing address

18323 98TH AVE NE STE 4
BOTHELL WA
98011-3358
US

V. Phone/Fax

Practice location:
  • Phone: 425-485-8292
  • Fax: 425-485-5732
Mailing address:
  • Phone: 425-485-8292
  • Fax: 425-485-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KANAKO NAGATOMO
Title or Position: OWNER
Credential: DDS, MSD, PHD
Phone: 425-485-8292