Provider Demographics
NPI:1538603808
Name:HIGHLANDS KIDS DENTISTRY AND ORTHODONTICS
Entity type:Organization
Organization Name:HIGHLANDS KIDS DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOC
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-557-5437
Mailing Address - Street 1:2525 NE PARK DR
Mailing Address - Street 2:STE#B
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-2642
Mailing Address - Country:US
Mailing Address - Phone:425-557-5437
Mailing Address - Fax:425-557-0472
Practice Address - Street 1:2525 NE PARK DR
Practice Address - Street 2:STE#B
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-2642
Practice Address - Country:US
Practice Address - Phone:425-557-5437
Practice Address - Fax:425-557-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000103561223P0221X
WAFM06271091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty