Healthcare Provider Details

I. General information

NPI: 1972839488
Provider Name (Legal Business Name): BELLINGHAM DENTURE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 KING STREET
BELLINGHAM WA
98229
US

IV. Provider business mailing address

1329 KING STREET
BELLINGHAM WA
98229
US

V. Phone/Fax

Practice location:
  • Phone: 360-647-0395
  • Fax: 360-594-4387
Mailing address:
  • Phone: 360-647-0395
  • Fax: 360-594-4387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number00000395
License Number StateWA

VIII. Authorized Official

Name: CLAYTON M. SULEK
Title or Position: DENTURIST/OWNER
Credential: DN - DENTURIST
Phone: 360-305-9734