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General NPI Number Information
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NPI Number | 1326211525
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Entity Type | Organization
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Legal Business Name | NORTHWEST DENTAL HYGIENE
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 509 OLIVE WAY SUITE 1240
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City | SEATTLE
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State | WA
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Zip | 98101-1720
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Country | US
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Telephone | 206-325-4763
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Fax | 206-325-4763
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Provider Business Mailing Address
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Address Line | 1033 36TH AVE E
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City | SEATTLE
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State | WA
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Zip | 98112-4323
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Country | US
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Telephone | 206-325-4763
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Fax | 206-325-4763
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SUSAN L CARLSON
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Credential | RDH, BS
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Telephone | 206-325-4763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | WA 1002
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License Number State | WA
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