NPIMap

Organization Active NPI

Puget Sound Dental Professionals PLLC

  • General Practice Dentistry
  • Everett, WA
National Provider Identifier
1609443407
Registry record updated Jun 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PUGET SOUND DENTAL PROFESSIONALS PLLC
Practice address
3224 Colby Ave Ste a
Everett, WA 98201-4383
Phone
(425) 259-3505
NPI assigned
Jun 9, 2021
Last updated
Jun 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2021

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

Authorized official

Name
Jessica Knight
Title
Credentialing Manager
Phone
(360) 659-8100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

3224 Colby Ave Ste a
Everett, WA 98201-4383

Mailing address

3224 Colby Ave Ste a
Everett, WA 98201-4383
Phone (425) 259-3505

Other names 1

  • Everett Dental Professionals Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1609443407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3224 COLBY AVE STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014383",
            "telephone_number": "425-259-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3224 COLBY AVE STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014383",
            "telephone_number": "425-259-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND DENTAL PROFESSIONALS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "360-659-8100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Everett Dental Professionals",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.