Healthcare Provider Details

I. General information

NPI: 1174509061
Provider Name (Legal Business Name): IMRE GYARMATI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 214TH AVE E SUITE A
BONNEY LAKE WA
98391-3910
US

IV. Provider business mailing address

9925 214TH AVE E SUITE A
BONNEY LAKE WA
98391-3910
US

V. Phone/Fax

Practice location:
  • Phone: 253-863-4594
  • Fax: 253-863-5061
Mailing address:
  • Phone: 253-863-4594
  • Fax: 253-863-5061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00007457
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: