# SEQUIM FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1538613112
- **Authorized official:** HEIDI JOHNSON (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (360) 681-8884

## Contact information

- **Practice address:** 321 N SEQUIM AVE \# B, SEQUIM, WA 98382-3457
- **Practice address phone:** (360) 681-8884
- **Mailing address:** PO BOX 3430, SEQUIM, WA 98382-5028
- **Mailing address phone:** (360) 681-8884

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 10482 | WA | — |
| 122300000X | Dentist | 5445 | WA | Yes |

## Other

- **Enumeration date:** 08/11/2016
- **Last updated:** 08/11/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1144212804 | INDIVIDUAL NPI | WA |
| 01 | — | 1952398661 | INDIVIDUAL NPI | WA |