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Organization
MOUNTAIN SMILES - KIRKLAND DENTAL PLLC
Active
Organization
MOUNTAIN SMILES - KIRKLAND DENTAL PLLC
Active
Other names
Elite Dental Studio, Optima Dental Spa
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL GIMENEZ (CREDENTIALING SR. MANAGER)
(719) 300-5933
Entity
Organization
Contact information
Practice address
11830 NE 128TH ST STE 201, KIRKLAND, WA 98034-7202
(425) 823-6820
Mailing address
11830 NE 128TH ST STE 201, KIRKLAND, WA 98034-7202
(425) 823-6820
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
NULL
122300000X
Dentist
Primary
—
—
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
05/01/2026
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