Provider Demographics
NPI:1063923381
Name:PERFECT SMILE ORTHODONTICS PLLC
Entity type:Organization
Organization Name:PERFECT SMILE ORTHODONTICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-676-9222
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-0966
Mailing Address - Country:US
Mailing Address - Phone:360-676-9222
Mailing Address - Fax:360-676-9223
Practice Address - Street 1:2141 WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9183
Practice Address - Country:US
Practice Address - Phone:360-676-9222
Practice Address - Fax:360-676-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000094701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty