Healthcare Provider Details

I. General information

NPI: 1497190201
Provider Name (Legal Business Name): NORTHEAST SEATTLE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 35TH AVE NE SUITE 8
SEATTLE WA
98115-7344
US

IV. Provider business mailing address

6850 35TH AVE NE SUITE 8
SEATTLE WA
98115-7344
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-8020
  • Fax: 206-524-9028
Mailing address:
  • Phone: 206-524-8020
  • Fax: 206-524-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8819
License Number StateWA

VIII. Authorized Official

Name: DR. CHAD CARVER
Title or Position: ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 206-524-8020