Healthcare Provider Details

I. General information

NPI: 1326959610
Provider Name (Legal Business Name): SMILE STUDIO NW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4412 HARBOUR POINTE BLVD SW SUITE 202
MUKILTEO WA
98275
US

IV. Provider business mailing address

4412 HARBOUR POINTE BLVD SW SUITE 202
MUKILTEO WA
98275
US

V. Phone/Fax

Practice location:
  • Phone: 425-375-0079
  • Fax:
Mailing address:
  • Phone: 425-375-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW BRUNER
Title or Position: ORTHODONTIST
Credential: DDS, MS
Phone: 425-375-0079