Provider Demographics
NPI:1588242127
Name:MICHELLE J AMENT, DDS, PLLC
Entity type:Organization
Organization Name:MICHELLE J AMENT, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JACLYN
Authorized Official - Last Name:AMENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-860-1909
Mailing Address - Street 1:13475 NE VILLAGE SQUARE DR UNIT D505
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-5009
Mailing Address - Country:US
Mailing Address - Phone:248-860-1909
Mailing Address - Fax:
Practice Address - Street 1:19214 BOTHELL WAY NE STE B
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-6066
Practice Address - Country:US
Practice Address - Phone:248-860-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1316328487OtherPPO