Misty Ann Cervantes, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010553 Issued in WA

Practice address

1519 Alaskan Way S
Seattle, WA 98134-1102

Phone

(206) 217-6446

NPI assigned

Oct 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• J Kim & M Cervantes-Kim DDS PLLC

  dba Elliott Bay Dental Burien

  • Dental Clinic/Center
  • Burien, WA
  • NPI 1578294179
  NPD
• Kim & Cervantes-Kim DDS PLLC

  dba Elliott Bay Dental

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1730789082
  NPD

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689750739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35455 8TH AVE SOUTHWEST",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980238137",
            "telephone_number": "209-406-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 ALASKAN WAY S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981341102",
            "telephone_number": "206-217-6446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERVANTES",
        "first_name": "MISTY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010553",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "52835",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Certified Lab Services
• Jennifer Cerulli, LMP
• Francisco Cervantes Contreras, MD
• Felomina Corazon Cervantes, CG
• Marianna Victoria Cervantes
• Trinity Cervantes
• Vanessa Michelle Cervantes, M.D.
• Christine Leanne Cervenka, MSW
• Jose Andres Cervera-Servin, MD
• Lawrence Nicholas Cetrulo, M.D.

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

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