Provider Demographics
NPI:1063751527
Name:NORTH SEATTLE ORTHODONTICS PS
Entity type:Organization
Organization Name:NORTH SEATTLE ORTHODONTICS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:206-523-1047
Mailing Address - Street 1:11011 MERIDIAN AVE N
Mailing Address - Street 2:STE. 304
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8967
Mailing Address - Country:US
Mailing Address - Phone:206-523-1047
Mailing Address - Fax:206-523-0740
Practice Address - Street 1:11011 MERIDIAN AVE N
Practice Address - Street 2:STE. 304
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8967
Practice Address - Country:US
Practice Address - Phone:206-523-1047
Practice Address - Fax:206-523-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000086741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty