Organization
PACIFIC CHILDRENS DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARJA KAAKKO (PRESIDENT)
(206) 355-1596
Entity
Organization
Contact information
Practice address
916 PACIFIC AVE, EVERETT, WA 98201-4147
(206) 355-1596
Mailing address
700 NW GILMAN BLVD, E-103, #493, ISSAQUAH, WA 98027-5395
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
9397
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306911383
PERSONAL NPI 1306911383
WA
05
—
5056239
—
WA
Enumeration date
01/03/2012
Last updated
01/03/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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