NPIMap

Organization Active NPI

South Sound Dentures, P.S.

  • Dentist
  • Olympia, WA
National Provider Identifier
1487974341
Registry record updated Jun 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE10844 Issued in WA
Legal business name
SOUTH SOUND DENTURES, P.S.
Practice address
1822 Black Lake Blvd. SW Suite 101
Olympia, WA 98512
Phone
(360) 709-9909
NPI assigned
Jun 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2010

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

Authorized official

Name
Mrs. Heidi Anne Ellis, D.H.NPI 1285853788
Title
Owner
Phone
(360) 709-9909

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DE10844 WA Primary

Addresses

Primary practice location

1822 Black Lake Blvd. SW Suite 101
Olympia, WA 98512

Mailing address

1822 Black Lake Blvd SW Ste 101
Olympia, WA 98512-5628
Phone (360) 709-9909

National Provider Directory

National Provider Directory

Locations

1822 Black Lake Blvd SW
Ste 101
Olympia, WA 98512
Phone (360) 704-0086

Practitioners & affiliated clinicians

Practitioners 2

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": "1275436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275436800000",
    "number": "1487974341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1822 BLACK LAKE BLVD SW STE 101",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985125628",
            "telephone_number": "360-709-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1822 BLACK LAKE BLVD. SW SUITE 101",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "98512",
            "telephone_number": "360-709-9909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SOUND DENTURES, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-02",
        "last_updated": "2010-06-02",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-709-9909",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "D.H."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE10844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2010; 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.