Organization Active NPI

Walla Walla Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Walla Walla, WA
National Provider Identifier
1184284689
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
WALLA WALLA ORTHODONTICS
Practice address
1608 Penny LN
Walla Walla, WA 99362-4477
Phone
(509) 525-7030
Fax
(509) 522-3704
NPI assigned
Jun 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

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

Authorized official

Name
Brianna Crewse
Title
Financial Coordinator
Phone
(509) 525-7030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

1608 Penny LN
Walla Walla, WA 99362-4477

Mailing address

1608 Penny LN
Walla Walla, WA 99362-4477
Phone (509) 525-7030

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560729600000",
    "number": "1184284689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 PENNY LN",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624477",
            "telephone_number": "509-525-7030",
            "fax_number": "509-522-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1608 PENNY LN",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624477",
            "telephone_number": "509-525-7030",
            "fax_number": "509-522-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLA WALLA ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A",
        "authorized_official_last_name": "CREWSE",
        "authorized_official_first_name": "BRIANNA",
        "authorized_official_title_or_position": "FINANCIAL COORDINATOR",
        "authorized_official_telephone_number": "509-525-7030"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; 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.