Provider Demographics
NPI:1275362840
Name:NORTHWEST SMILES
Entity type:Organization
Organization Name:NORTHWEST SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:JAE
Authorized Official - Last Name:JOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-759-1270
Mailing Address - Street 1:1545 WILMINGTON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9032
Mailing Address - Country:US
Mailing Address - Phone:253-581-6779
Mailing Address - Fax:
Practice Address - Street 1:1545 WILMINGTON DR STE 100
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9032
Practice Address - Country:US
Practice Address - Phone:253-581-6779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental