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General NPI Number Information
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NPI Number | 1083168512
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Entity Type | Organization
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Legal Business Name | NORTHWEST SMILE DENTAL AND DENTURE
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 7233 MARTIN WAY E
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City | OLYMPIA
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State | WA
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Zip | 98516-5534
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Country | US
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Telephone | 360-489-0991
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Fax | 360-915-6214
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Provider Business Mailing Address
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Address Line | 7233 MARTIN WAY E
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City | OLYMPIA
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State | WA
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Zip | 98516-5534
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Country | US
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Telephone | 360-489-0991
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Fax | 360-915-6214
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Authorized Official
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Title or Position | DENTURIST
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Name | MRS. YOUNI CHO BEALE
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Credential | D.P.D
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Telephone | 360-489-0991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 604003708
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License Number State | WA
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