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General NPI Number Information
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NPI Number | 1538603808
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Entity Type | Organization
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Legal Business Name | HIGHLANDS KIDS DENTISTRY AND ORTHODONTICS
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 2525 NE PARK DR STE#B
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City | ISSAQUAH
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State | WA
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Zip | 98029-2642
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Country | US
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Telephone | 425-557-5437
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Fax | 425-557-0472
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Provider Business Mailing Address
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Address Line | 2525 NE PARK DR STE#B
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City | ISSAQUAH
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State | WA
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Zip | 98029-2642
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Country | US
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Telephone | 425-557-5437
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Fax | 425-557-0472
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LOC TRAN
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Credential |
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Telephone | 425-557-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE00010356
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | FM0627109
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License Number State | WA
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