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
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