Mountain Smiles - Kirkland Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MOUNTAIN SMILES - KIRKLAND DENTAL PLLC

Doing business as

Elite Dental Studio
Optima Dental Spa

Practice address

11830 NE 128TH St Ste 201
Kirkland, WA 98034-7202

Phone

(425) 823-6820

NPI assigned

Feb 19, 2025

Last updated

May 1, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Angel Gimenez

Title

Credentialing Sr. Manager

Phone

(719) 300-5933

Specialties & licenses 10

Addresses

Other names 2

• Elite Dental Studio Doing business as
• Optima Dental Spa Doing business as

Tax ID family

Elite Dental Studio2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mountain Smiles - Longview Dental, PLLC

  dba Smiles Dental

  • Dentist
  • Longview, WA
  • NPI 1528867108
  NPD tax ID

Locations

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.

• David Gimre Richardson, D.D.S.

  • General Practice Dentistry
  • Kirkland, WA
  • NPI 1629119284
  NPD (past)

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

{
    "created_epoch": "1739923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777593600000",
    "number": "1477359628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11830 NE 128TH ST STE 201",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347202",
            "telephone_number": "425-823-6820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11830 NE 128TH ST STE 201",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347202",
            "telephone_number": "425-823-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN SMILES - KIRKLAND DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-19",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A",
        "authorized_official_last_name": "GIMENEZ",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_title_or_position": "CREDENTIALING SR. MANAGER",
        "authorized_official_telephone_number": "719-300-5933"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dental Studio",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optima Dental Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2026; 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.