NPIMap

Organization Active NPI

Martha Lake Dental Center

  • Dentist
  • Lynnwood, WA
National Provider Identifier
1649475799
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE9941 Issued in WA
Legal business name
MARTHA LAKE DENTAL CENTER
Practice address
1233 164TH St SW
Ste #H
Lynnwood, WA 98087
Phone
(425) 787-2402
Fax
(425) 787-5350
NPI assigned
Jun 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Andrew T Tran, DDSNPI 1588088934
Title
President
Phone
(425) 787-2402

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DE9941 WA Primary

Addresses

Primary practice location

1233 164TH St SW
Ste #H
Lynnwood, WA 98087

Mailing address

1233 164TH St SW
Ste #H
Lynnwood, WA 98087
Phone (425) 787-2402

National Provider Directory

National Provider Directory
Tax ID family
Martha Lake Dental Center2 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.

Locations

1233 164th St SW
Ste H
Lynnwood, WA 98087
Phone (425) 787-2402

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649475799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 164TH ST SW",
            "address_2": "STE #H",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "98087",
            "telephone_number": "425-787-2402",
            "fax_number": "425-787-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 164TH ST SW",
            "address_2": "STE #H",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "98087",
            "telephone_number": "425-787-2402",
            "fax_number": "425-787-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTHA LAKE DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-787-2402",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE9941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.