Mountain Smiles - Longview Dental, PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MOUNTAIN SMILES - LONGVIEW DENTAL, PLLC

Doing business as

Smiles Dental

Practice address

900 Fir St Ste 1D
Longview, WA 98632-2544

Phone

(360) 261-6094

Fax

(360) 577-0566

NPI assigned

Mar 7, 2025

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 Senior Manager

Phone

(719) 300-5933

Specialties & licenses 11

Addresses

Other names 1

• Smiles Dental 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 - Kirkland Dental PLLC

  dba Elite Dental Studio

  • Dentist
  • Kirkland, WA
  • NPI 1477359628
  NPD tax ID

Locations

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

{
    "created_epoch": "1741305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1528867108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 FIR ST STE 1D",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322544",
            "telephone_number": "360-261-6094",
            "fax_number": "360-577-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 FIR ST STE 1D",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322544",
            "telephone_number": "360-261-6094",
            "fax_number": "360-577-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN SMILES - LONGVIEW DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-07",
        "last_updated": "2025-03-07",
        "certification_date": "2025-02-18",
        "status": "A",
        "authorized_official_last_name": "GIMENEZ",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_title_or_position": "CREDENTIALING SENIOR MANAGER",
        "authorized_official_telephone_number": "719-300-5933"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Denturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smiles Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christie L Morton, CCSH, RPSGT
• Daniel Moser, PHARMD
• Dane L. Moseson, M.D.
• Binal Motawar
• Kathleen Michelle Moullet, PHARMD
• Mountain Smiles, PLLC
• Stevie L Moyer
• Ken Mubeen, AAC, CPC
• Irene Mudehwe, NURSE PRACTITIONER
• Sara Talal Muhtaseb, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; 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.