=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063599702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAUMANN JOHNSON ORTHODONTICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3511 N W BUCKLIN HILL RD
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-337-2020
-----------------------------------------------------
Fax | 360-337-2021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3511 N W BUCKLIN HILL RD
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-337-2020
-----------------------------------------------------
Fax | 360-337-2021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER ASSOCIATE
-----------------------------------------------------
Name | DR. SIEGFRIED ARIEL NAUMANN
-----------------------------------------------------
Credential | DDS MS
-----------------------------------------------------
Telephone | 360-337-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DE00008314
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------