Fairwood Orthodontics

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DE00008957 Issued in WA

Legal business name

FAIRWOOD ORTHODONTICS

Doing business as

Mercer Island Orthodontics

Practice address

14300 SE Petrovitsky Road
Renton, WA 98058

Phone

(425) 235-8800

Fax

(425) 235-0288

NPI assigned

Dec 12, 2006

Organization subpart

No

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

Authorized official

Name

Mario D Chorak, DMD

Title

Orthodontist Owner

Phone

(425) 235-8800

Specialties & licenses 1

Addresses

Other names 1

• Mercer Island Orthodontics Doing business as

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218153600000",
    "number": "1619037157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14300 SE PETROVITSKY ROAD",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98058",
            "telephone_number": "425-235-8800",
            "fax_number": "425-235-0288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14300 SE PETROVITSKY ROAD",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "98058",
            "telephone_number": "425-235-8800",
            "fax_number": "425-235-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWOOD ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2008-08-08",
        "status": "A",
        "authorized_official_last_name": "CHORAK",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ORTHODONTIST OWNER",
        "authorized_official_telephone_number": "425-235-8800",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WA",
            "license": "DE00008957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercer Island Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James Robert Fackelman, MD
• Season Fagan
• Fairwood Chiropractic Clinic
• Fairwood Dental LLC (Comfort Dental Fairwood)
• Fairwood Hearing Care, PLLP (Fairwood Hearing Care)
• Fairwood Pedodonticsllc (Comfort Dental Kids Fairwood)
• Beth S Falanga, ND
• Jennifer Rae Faline, LMP
• Emily S Falkenstein, LMP
• Family Nemt LLC

• Orthodontics and Dentofacial Orthopedics Dentistry in Renton, WA
• Providers in Renton, WA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2008; 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.