North Bend Pediatric Dentistry, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

NORTH BEND PEDIATRIC DENTISTRY, LLC

Doing business as

North Bend Pediatric Dentistry

Practice address

406 Main Ave S
North Bend, WA 98045-8215

Phone

(206) 383-9338

NPI assigned

Nov 19, 2024

Last updated

Nov 19, 2024By 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

Amelia Chim, DDS, MSDNPI 1003234899

Title

Dentist

Phone

(206) 383-9338

Specialties & licenses 1

Addresses

Other names 1

• North Bend Pediatric Dentistry Doing business as

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.

• Amelia Chim

  • Pediatric Dentistry
  • Seattle, WA
  • NPI 1003234899
  NPD Authorized official

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

{
    "created_epoch": "1731974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1568287258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 MAIN AVE S",
            "city": "NORTH BEND",
            "state": "WA",
            "postal_code": "980458215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 MAIN AVE S",
            "city": "NORTH BEND",
            "state": "WA",
            "postal_code": "980458215",
            "telephone_number": "206-383-9338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH BEND PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-19",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "CHIM",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "206-383-9338",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Bend Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Newman, BCBA
• Laura Nicolosi, LMP
• North Bend Anesthesia Billing, LLC
• North Bend Chiropractic and Golf Fitness Center PLLC
• North Bend Dental Care LLC
• North Bend Therapeutic Massage
• NW Medical LLC
• Crystal L O'Brien, CMA, LMP
• Tracy A Oban Bear, PTA
• Patrick Howard Odonnell, DDS

• Pediatric Dentistry in North Bend, WA
• Providers in North Bend, WA by specialty
• Pediatric Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.