NPIMap

Organization Active NPI

CHC of Snohomish County 112TH Dental

  • Dentist
  • Everett, WA
National Provider Identifier
1649460288
Registry record updated Jul 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
5010921 Issued in WA
Legal business name
CHC OF SNOHOMISH COUNTY 112TH DENTAL
Practice address
1019 112TH St SW
Everett, WA 98204
Phone
(425) 551-6001
Fax
(425) 551-6008
NPI assigned
Jul 30, 2007
Last updated
Jul 30, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2007

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

Authorized official

Name
Mr. Kenneth M Green
Title
Executive Director
Phone
(425) 789-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 5010921 WA Primary

Addresses

Primary practice location

1019 112TH St SW
Everett, WA 98204

Mailing address

PO Box 13060
Everett, WA 98206-3060
Phone (425) 789-3700

Other identifiers 1

IdentifierTypeStateIssuer
5010921MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Comm HLTH Ctr Snohomis Cty29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1649460288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13060",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982063060",
            "telephone_number": "425-789-3700",
            "fax_number": "425-789-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 112TH ST SW",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "98204",
            "telephone_number": "425-551-6001",
            "fax_number": "425-551-6008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHC OF SNOHOMISH COUNTY 112TH DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "425-789-3700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "5010921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5010921",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 30, 2007; 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.