NPIMap

Organization Active NPI

Brian Moody, DDS, PLLC

Doing business as Creekside Dental

  • General Practice Dentistry
  • Bothell, WA
National Provider Identifier
1689128746
Registry record updated Aug 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00010023 Issued in WA
Legal business name
BRIAN MOODY, DDS, PLLC
Doing business as
Creekside Dental
Practice address
19214 Bothell Way NE
Suite C
Bothell, WA 98011-6066
Phone
(425) 485-0300
NPI assigned
Aug 6, 2016
Last updated
Aug 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2016

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

Authorized official

Name
Dr. Brian Moody, DDSNPI 1750416327
Title
Owner
Phone
(425) 485-0300

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DE00010023 WA Primary

Addresses

Primary practice location

19214 Bothell Way NE
Suite C
Bothell, WA 98011-6066

Mailing address

19214 Bothell Way NE
Suite C
Bothell, WA 98011-6066
Phone (425) 485-0300

Other names 1

  • Creekside Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1470441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470441600000",
    "number": "1689128746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19214 BOTHELL WAY NE",
            "address_2": "SUITE C",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980116066",
            "telephone_number": "425-485-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19214 BOTHELL WAY NE",
            "address_2": "SUITE C",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980116066",
            "telephone_number": "425-485-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN MOODY, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-06",
        "last_updated": "2016-08-06",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-485-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creekside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2016; 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.