Healthcare Provider Details

I. General information

NPI: 1326211525
Provider Name (Legal Business Name): NORTHWEST DENTAL HYGIENE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY SUITE 1240
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

1033 36TH AVE E
SEATTLE WA
98112-4323
US

V. Phone/Fax

Practice location:
  • Phone: 206-325-4763
  • Fax: 206-325-4763
Mailing address:
  • Phone: 206-325-4763
  • Fax: 206-325-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberWA 1002
License Number StateWA

VIII. Authorized Official

Name: SUSAN L CARLSON
Title or Position: OWNER/PRESIDENT
Credential: RDH, BS
Phone: 206-325-4763