Provider Demographics
NPI:1972113652
Name:SILVERLAKE ORTHODONTICS
Entity type:Organization
Organization Name:SILVERLAKE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSC
Authorized Official - Phone:425-338-5414
Mailing Address - Street 1:10812 19TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5153
Mailing Address - Country:US
Mailing Address - Phone:425-338-5414
Mailing Address - Fax:425-338-5744
Practice Address - Street 1:10812 19TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5153
Practice Address - Country:US
Practice Address - Phone:425-338-5414
Practice Address - Fax:425-338-5744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty