NPIMap

Organization Active NPI

Meridian Dental Clinic, LLC

  • General Practice Dentistry
  • Kent, WA
National Provider Identifier
1124234216
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MERIDIAN DENTAL CLINIC, LLC
Practice address
422 E Smith St
Kent, WA 98030-4546
Phone
(253) 852-3033
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark V Walker, DDSNPI 1407857279
Title
Managing Member
Phone
(253) 852-3033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X WA Primary

Addresses

Primary practice location

422 E Smith St
Kent, WA 98030-4546

Mailing address

422 E Smith St
Kent, WA 98030-4546
Phone (253) 852-3033

National Provider Directory

National Provider Directory

Locations

422 E Smith St
Kent, WA 98030
Phone (253) 852-3033

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124234216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 E SMITH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980304546",
            "telephone_number": "253-852-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 E SMITH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980304546",
            "telephone_number": "253-852-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN DENTAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "253-852-3033",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.