Organization
MOUNTAIN SMILES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL GIMENEZ (CREDENTIALING MANAGER)
(719) 300-5933
Entity
Organization
Contact information
Practice address
727 TRAIL RD, SEDRO WOOLLEY, WA 98284-9335
(360) 856-4540
Mailing address
727 TRAIL RD, SEDRO WOOLLEY, WA 98284-9335
(719) 300-5933
(719) 300-5933
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223D0004X
Dental Anesthesiology
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
122400000X
Denturist
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Enumeration date
02/19/2025
Last updated
02/27/2025
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