Provider Demographics
NPI:1871214239
Name:CHLOE MIRICK DDS PLLC
Entity type:Organization
Organization Name:CHLOE MIRICK DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MIRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-200-7337
Mailing Address - Street 1:22820 96TH PL S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2984
Mailing Address - Country:US
Mailing Address - Phone:206-200-7337
Mailing Address - Fax:
Practice Address - Street 1:31213 3RD AVE STE TBD
Practice Address - Street 2:
Practice Address - City:BLACK DIAMOND
Practice Address - State:WA
Practice Address - Zip Code:98010-9718
Practice Address - Country:US
Practice Address - Phone:206-200-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty