NPIMap

Organization Active NPI

Packard, Packard & Packard, PS

  • General Practice Dentistry
  • Yakima, WA
National Provider Identifier
1811085665
Registry record updated Mar 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
601472726 Issued in WA
Legal business name
PACKARD, PACKARD & PACKARD, PS
Practice address
1501 S 40TH Ave
Yakima, WA 98908-3963
Phone
(509) 577-8277
Fax
(509) 573-4858
NPI assigned
Oct 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2011

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

Authorized official

Name
Leslee R Thysell
Title
Office Manager
Phone
(509) 577-8277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 601472726 WA Primary

Addresses

Primary practice location

1501 S 40TH Ave
Yakima, WA 98908-3963

Mailing address

1501 S 40TH Ave
Yakima, WA 98908-3963
Phone (509) 577-8277

Other identifiers 1

IdentifierTypeStateIssuer
5020037MedicaidWA

Other names 1

  • Creekside Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1501 S 40th Ave
Yakima, WA 98908
Phone (509) 577-8277

Practitioners & affiliated clinicians

Practitioners 4

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": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301356800000",
    "number": "1811085665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 S 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083963",
            "telephone_number": "509-577-8277",
            "fax_number": "509-573-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083963",
            "telephone_number": "509-577-8277",
            "fax_number": "509-573-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACKARD, PACKARD & PACKARD, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2011-03-29",
        "status": "A",
        "authorized_official_last_name": "THYSELL",
        "authorized_official_first_name": "LESLEE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "509-577-8277"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "601472726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5020037",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creekside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; 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.