Cottage Lake Family Dentistry, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

COTTAGE LAKE FAMILY DENTISTRY, PLLC

Practice address

19150 NE Woodinville Duvall Rd
Woodinville, WA 98077-9477

Phone

(425) 788-8900

Fax

(425) 788-3936

NPI assigned

May 7, 2024

Organization subpart

No

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

Authorized official

Name

Nick Sundiam

Title

Credentialing Manager

Phone

(719) 300-5933

Specialties & licenses 1

Addresses

Other names 1

• Cottage Lake Family Dentistry Doing business as

Locations

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

{
    "created_epoch": "1715040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1932957909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19150 NE WOODINVILLE DUVALL RD",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980779477",
            "telephone_number": "425-788-8900",
            "fax_number": "425-788-3936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19150 NE WOODINVILLE DUVALL RD",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980779477",
            "telephone_number": "425-788-8900",
            "fax_number": "425-788-3936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTAGE LAKE FAMILY DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-07",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "SUNDIAM",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-300-5933"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cottage Lake Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providers in Woodinville, 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 May 7, 2024; 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.