Healthcare Provider Details

I. General information

NPI: 1265979330
Provider Name (Legal Business Name): AUBURN DENTURE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 E MAIN ST UNIT 5
AUBURN WA
98002-5748
US

IV. Provider business mailing address

1268 E MAIN ST UNIT 5
AUBURN WA
98002-5748
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7799
  • Fax:
Mailing address:
  • Phone: 253-833-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN00000258
License Number StateWA

VIII. Authorized Official

Name: SATOMI HIRAI
Title or Position: LICENSED DENTURIST
Credential: LD
Phone: 253-833-7793