Healthcare Provider Details

I. General information

NPI: 1013830264
Provider Name (Legal Business Name): OTGONBOLD DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6504 WOLLOCHET DR
GIG HARBOR WA
98335-8319
US

IV. Provider business mailing address

6504 WOLLOCHET DR
GIG HARBOR WA
98335-8319
US

V. Phone/Fax

Practice location:
  • Phone: 253-858-5869
  • Fax: 253-858-5849
Mailing address:
  • Phone: 253-858-5869
  • Fax: 253-858-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MURUUDUL OTGONBOLD
Title or Position: PRESIDENT
Credential: DDS
Phone: 720-383-8644