Provider Demographics
NPI:1861948713
Name:SUMNER SMILES DENTISTRY
Entity type:Organization
Organization Name:SUMNER SMILES DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKOLINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-863-4400
Mailing Address - Street 1:1211 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1416
Mailing Address - Country:US
Mailing Address - Phone:253-863-4400
Mailing Address - Fax:253-863-2336
Practice Address - Street 1:1211 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1416
Practice Address - Country:US
Practice Address - Phone:253-863-4400
Practice Address - Fax:253-863-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60146593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty