# MOUNTAIN SMILES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164228318
- **Authorized official:** ANGEL GIMENEZ (CREDENTIALING MANAGER)
- **Authorized official phone:** (719) 300-5933

## Contact information

- **Practice address:** 820 OCEAN BEACH HWY STE 110, LONGVIEW, WA 98632-4081
- **Practice address phone:** (360) 577-0566
- **Mailing address:** 820 OCEAN BEACH HWY STE 110, LONGVIEW, WA 98632-4081
- **Mailing address phone:** (360) 577-0566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |
| 1223D0004X | Dental Anesthesiology | — | NULL | — |
| 1223D0004X | Dental Anesthesiology | — | — | — |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223P0700X | Prosthodontics | — | NULL | — |
| 1223P0700X | Prosthodontics | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |
| 122400000X | Denturist | — | NULL | — |
| 122400000X | Denturist | — | — | — |
| 124Q00000X | Dental Hygienist | — | NULL | — |
| 124Q00000X | Dental Hygienist | — | — | — |
| 126800000X | Dental Assistant | — | NULL | — |
| 126800000X | Dental Assistant | — | — | — |

## Other

- **Enumeration date:** 02/19/2025
- **Last updated:** 02/27/2025