NPIMap

Organization Active NPI

Washington Dental Corporation, PC

Doing business as Woodinville Modern Dentistry

  • General Practice Dentistry
  • Woodinville, WA
National Provider Identifier
1194483354
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WASHINGTON DENTAL CORPORATION, PC
Doing business as
Woodinville Modern Dentistry
Practice address
14239 NE Woodinville Duvall Rd Unit 21
Woodinville, WA 98072-8564
Phone
(425) 458-2859
Fax
(425) 458-2230
NPI assigned
Dec 6, 2021
Last updated
Dec 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Authorized official

Name
Jessica Ahn, DMD
Title
Owner
Phone
(425) 458-2859

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

14239 NE Woodinville Duvall Rd Unit 21
Woodinville, WA 98072-8564

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Woodinville Modern Dentistry Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2340504Woodinville Modern Dentistry14239 NE Woodinville-Duvall Rd, Unit 21, Woodinville, WA 98072Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Washington Dental Corporation48 organizations share this tax ID, including this one

Other organizations with this tax ID 47

Organizations that report the same tax identification number in the National Provider Directory.

View all 47

Locations

14239 NE Woodinville Duvall Rd
Unit 21
Woodinville, WA 98072
Phone (425) 458-2859

Practitioners & affiliated clinicians

Practitioners 2

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": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638748800000",
    "number": "1194483354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14239 NE WOODINVILLE DUVALL RD UNIT 21",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980728564",
            "telephone_number": "425-458-2859",
            "fax_number": "425-458-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON DENTAL CORPORATION, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A",
        "authorized_official_last_name": "AHN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-458-2859",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodinville Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodinville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.