Healthcare Provider Details

I. General information

NPI: 1437595063
Provider Name (Legal Business Name): DENT & HENRY D.D.S., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21112 MERIDIAN AVE E
GRAHAM WA
98338
US

IV. Provider business mailing address

P.O. BOX 70
GRAHAM WA
98338
US

V. Phone/Fax

Practice location:
  • Phone: 253-847-1964
  • Fax: 253-846-1905
Mailing address:
  • Phone: 253-847-1964
  • Fax: 253-846-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARILYN HENRY
Title or Position: GENERAL MANAGER
Credential:
Phone: 253-847-1964