NPIMap

Organization Active NPI

PSPD - Lake Stevens PLLC

Doing business as Puget Sound Pediatric Dentistry

  • Pediatric Dentistry
  • Lake Stevens, WA
National Provider Identifier
1154675064
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
DE00009918 Issued in WA
Legal business name
PSPD - LAKE STEVENS PLLC
Doing business as
Puget Sound Pediatric Dentistry
Practice address
9421 N. Davies Road #a
Lake Stevens, WA 98258
Phone
(425) 367-4149
Fax
(425) 609-4530
NPI assigned
Oct 30, 2012
Last updated
Apr 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LUGO DMD MARYSVILLE PSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Mrs. Jessica R Knight
Title
Account Receivable Manager
Phone
(425) 367-4149

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU
Pediatric Dentistry 1223P0221X DE00009918 WA Primary

Addresses

Primary practice location

9421 N. Davies Road #a
Lake Stevens, WA 98258

Mailing address

9421 N. Davies Road #a
Lake Stevens, WA 98258
Phone (425) 367-4149

Other names 1

  • Puget Sound Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

9421 N Davies Rd
#A
Lake Stevens, WA 98258
Phone (425) 367-4149

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1154675064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9421 N. DAVIES ROAD #A",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "98258",
            "telephone_number": "425-367-4149",
            "fax_number": "425-609-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9421 N. DAVIES ROAD #A",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "98258",
            "telephone_number": "425-367-4149",
            "fax_number": "425-609-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSPD - LAKE STEVENS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUGO DMD MARYSVILLE PS",
        "enumeration_date": "2012-10-30",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ACCOUNT RECEIVABLE MANAGER",
        "authorized_official_telephone_number": "425-367-4149",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WA",
            "license": "DE00009918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puget Sound Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Puget Sound Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Stevens, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; 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.