# REVIVE SMILES DENTISTRY, LLC

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

## Provider details

- **NPI number:** 1184135881
- **Authorized official:** DR. BILL S WONG DDS (OWNER/DDS)
- **Authorized official phone:** (206) 829-8565

## Contact information

- **Practice address:** 259 YALE AVE N, SEATTLE, WA 98109-5430
- **Practice address phone:** (206) 829-8565
- **Mailing address:** 259 YALE AVE N, SEATTLE, WA 98109-5430
- **Mailing address phone:** (206) 829-8565
- **Mailing address fax:** (206) 739-5797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 9084 | WA | Yes |

## Other

- **Enumeration date:** 10/20/2017
- **Last updated:** 03/19/2021