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General NPI Number Information
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NPI Number | 1528508322
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Entity Type | Organization
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Legal Business Name | SMILES BY DESIGN PLLC
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 7530 164TH AVE NE
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City | REDMOND
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State | WA
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Zip | 98052-7812
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Country | US
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Telephone | 425-558-1515
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Fax | 425-882-1040
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Provider Business Mailing Address
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Address Line | 7530 164TH AVE NE
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City | REDMOND
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State | WA
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Zip | 98052-7812
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Country | US
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Telephone | 425-558-1515
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Fax | 425-882-1040
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Authorized Official
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Title or Position | OWNER
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Name | SHAWN KELLER
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Credential | DDS
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Telephone | 425-558-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00009100
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License Number State | WA
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