=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063751527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH SEATTLE ORTHODONTICS PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2013
-----------------------------------------------------
Last Update Date | 02/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11011 MERIDIAN AVE N STE. 304
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-8967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-523-1047
-----------------------------------------------------
Fax | 206-523-0740
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11011 MERIDIAN AVE N STE. 304
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-8967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-523-1047
-----------------------------------------------------
Fax | 206-523-0740
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/ORTHODONTIST
-----------------------------------------------------
Name | DR. ELIZABETH LYONS
-----------------------------------------------------
Credential | DDS, MSD
-----------------------------------------------------
Telephone | 206-523-1047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DE00008674
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------