Mountain Smiles, Pllc

NPI #1083410237 in Lacey, Washington

Provider Information

NPI Number: 1083410237
Entity Type: Organization
Organization Name: Mountain Smiles, Pllc
Primary Specialty: Dentist
Enumeration Date: Feb 19, 2025
Last Updated: Feb 27, 2025

Practice Location

Address: 8765 TALLON LN NE # 1
City: Lacey
State: Washington
ZIP Code: 98516-6654
Phone: (360) 577-0566

Authorized Official

Name: ANGEL GIMENEZ
Title: CREDENTIALING MANAGER
Phone: (719) 300-5933

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Dental Anesthesiology — Dental Anesthesiology	1223D0004X
Dentist - Endodontics — Endodontics	1223E0200X
Dentist - General Practice — General Practice	1223G0001X
Dentist - Periodontics — Periodontics	1223P0300X
Dentist - Prosthodontics — Prosthodontics	1223P0700X
Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics	1223X0400X
Denturist	122400000X
Dental Hygienist	124Q00000X
Dental Assistant	126800000X
Dentist	122300000X	Primary

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