NPIMap

Organization Active NPI

South Lake Family Dentistry

  • Dentist
  • Lake Stevens, WA
National Provider Identifier
1275942518
Registry record updated Aug 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7981 Issued in WA
Legal business name
SOUTH LAKE FAMILY DENTISTRY
Practice address
10515 20TH St SE
Suite 201
Lake Stevens, WA 98258-4764
Phone
(425) 334-9600
Fax
(425) 334-9900
NPI assigned
Aug 12, 2014
Last updated
Aug 12, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2014

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

Authorized official

Name
Dr. Todd Miesel, DDSNPI 1487749701
Title
Owner
Phone
(425) 334-9600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 7981 WA Primary

Addresses

Primary practice location

10515 20TH St SE
Suite 201
Lake Stevens, WA 98258-4764

Mailing address

10515 20TH St SE
Suite 201
Lake Stevens, WA 98258-4764
Phone (425) 334-9600

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": "1407801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407801600000",
    "number": "1275942518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10515 20TH ST SE",
            "address_2": "SUITE 201",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982584764",
            "telephone_number": "425-334-9600",
            "fax_number": "425-334-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10515 20TH ST SE",
            "address_2": "SUITE 201",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982584764",
            "telephone_number": "425-334-9600",
            "fax_number": "425-334-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-12",
        "last_updated": "2014-08-12",
        "status": "A",
        "authorized_official_last_name": "MIESEL",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-334-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "7981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 12, 2014; 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.