NPIMap

Organization Active NPI

Green Lake Oral & Facial Surgery

  • Dentist
  • Shoreline, WA
National Provider Identifier
1457008435
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
GREEN LAKE ORAL & FACIAL SURGERY
Practice address
15823 Westminster Way N
Shoreline, WA 98133
Phone
(206) 848-5788
Fax
(206) 734-3747
NPI assigned
Mar 9, 2022
Organization subpart
Yes
Parent organization
GREEN LAKE ORAL & FACIAL SURGERYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Authorized official

Name
Dr. Matthew Shane EpsteinNPI 1417269200
Title
Owner/Provider
Phone
(206) 641-7212

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X Primary
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 204E00000X

Addresses

Primary practice location

15823 Westminster Way N
Shoreline, WA 98133

Mailing address

7900 E Green Lake Dr N
Suite 302
Seattle, WA 98103
Phone (360) 391-7872

National Provider Directory

National Provider Directory
Tax ID family
Green Lake Facial Surgery PLLC2 organizations share this tax ID, including this one
Part of
Green Lake Facial Surgery PLLC

Other organizations with this tax ID 1

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

Locations

7900 E Green Lake Dr N
Ste 302
Seattle, WA 98103
Phone (206) 641-7212

Practitioners & affiliated clinicians

Practitioners 3

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": "1646784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1457008435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 E GREEN LAKE DR N",
            "address_2": "SUITE 302",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98103",
            "telephone_number": "360-391-7872",
            "fax_number": "206-734-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15823 WESTMINSTER WAY N",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "98133",
            "telephone_number": "206-848-5788",
            "fax_number": "206-734-3747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LAKE ORAL & FACIAL SURGERY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREEN LAKE ORAL & FACIAL SURGERY",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "EPSTEIN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "206-641-7212",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreline, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.