NPIMap

Organization Active NPI

Korsmo & Henry DDD PS

Doing business as Puyallup Family Dental

  • General Practice Dentistry
  • Puyallup, WA
National Provider Identifier
1891158317
Registry record updated Apr 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5254 Issued in WA
Legal business name
KORSMO & HENRY DDD PS
Doing business as
Puyallup Family Dental
Practice address
5620 112TH St E
Suite 250
Puyallup, WA 98373-3206
Phone
(253) 770-0529
Fax
(253) 770-9638
NPI assigned
Apr 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2016

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

Authorized official

Name
Tamara Rosario
Title
Office Manager
Phone
(253) 770-0529

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5254 WA Primary

Addresses

Primary practice location

5620 112TH St E
Suite 250
Puyallup, WA 98373-3206

Mailing address

5620 112TH St E
Suite 250
Puyallup, WA 98373-3206
Phone (253) 770-0529

Other names 1

  • Puyallup Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Korsmo Henry DDD PS2 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

5620 112th St E
Ste 250
Puyallup, WA 98373
Phone (253) 770-0529

NPI Registry JSON

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

{
    "created_epoch": "1459468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1891158317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5620 112TH ST E",
            "address_2": "SUITE 250",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733206",
            "telephone_number": "253-770-0529",
            "fax_number": "253-770-9638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5620 112TH ST E",
            "address_2": "SUITE 250",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733206",
            "telephone_number": "253-770-0529",
            "fax_number": "253-770-9638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KORSMO & HENRY DDD PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-01",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "ROSARIO",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "253-770-0529"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "5254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puyallup Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.