NPIMap

Organization Active NPI

Mobile Dental Northwest, LLC

  • General Practice Dentistry
  • Tacoma, WA
National Provider Identifier
1700148152
Registry record updated Jun 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4923 Issued in WA
Legal business name
MOBILE DENTAL NORTHWEST, LLC
Practice address
1622 S Mildred St
Suite B
Tacoma, WA 98465-1610
Phone
(253) 432-4795
NPI assigned
Jun 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2012

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

Authorized official

Name
Dr. Gregory Robert Fisher, DDS
Title
Vice President- Finance
Phone
(253) 432-4795

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 4923 WA Primary

Addresses

Primary practice location

1622 S Mildred St
Suite B
Tacoma, WA 98465-1610

Mailing address

1622 S Mildred St
Suite B
Tacoma, WA 98465-1610
Phone (253) 432-4795

National Provider Directory

National Provider Directory

Locations

1622 S Mildred St
Ste B
Tacoma, WA 98465
Phone (253) 432-4795

NPI Registry JSON

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339459200000",
    "number": "1700148152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 S MILDRED ST",
            "address_2": "SUITE B",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984651610",
            "telephone_number": "253-432-4795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 S MILDRED ST",
            "address_2": "SUITE B",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984651610",
            "telephone_number": "253-432-4795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE DENTAL NORTHWEST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-12",
        "last_updated": "2012-06-12",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "VICE PRESIDENT- FINANCE",
        "authorized_official_telephone_number": "253-432-4795",
        "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": "4923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; 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.