Renton Smile Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DE60475234 Issued in WA

Legal business name

RENTON SMILE DENTISTRY

Practice address

1107 SW Grady Way
Suite 250
Renton, WA 98057-5217

Phone

(425) 687-8860

Fax

(425) 687-8863

NPI assigned

Dec 30, 2014

Last updated

Dec 30, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Elizabeth Nikolaeva Manchester, D.D.S.

Title

Dentist/Owner

Phone

(206) 802-8414

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1419897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1982092805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 SW GRADY WAY",
            "address_2": "SUITE 250",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980575217",
            "telephone_number": "425-687-8860",
            "fax_number": "425-687-8863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 SW GRADY WAY",
            "address_2": "SUITE 250",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980575217",
            "telephone_number": "425-687-8860",
            "fax_number": "425-687-8863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENTON SMILE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-30",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "MANCHESTER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "NIKOLAEVA",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "206-802-8414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "DE60475234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Renton Spa
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• Renton Spine Clinic

• Dental Clinic/Center in Renton, WA
• Providers in Renton, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; 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.