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General NPI Number Information
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NPI Number | 1871837732
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Entity Type | Organization
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Legal Business Name | CASCADE ORTHODONTICS
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 1109 S 348TH ST SUITE B
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7079
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Country | US
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Telephone | 253-944-1848
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Fax | 253-944-1857
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Provider Business Mailing Address
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Address Line | 1109 S 348TH ST SUITE B
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7079
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Country | US
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Telephone | 253-944-1848
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Fax | 253-944-1857
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CHRISTINE ANNA SIMONSON
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Credential | RDH
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Telephone | 206-293-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE 00010636
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License Number State | WA
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