Healthcare Provider Details

I. General information

NPI: 1538790357
Provider Name (Legal Business Name): DENNIS ABUGA OBUNGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA DENTAL HEALTH ACTIVITY 9900 LINCOLN STREET
JBLM WA
98431
US

IV. Provider business mailing address

USA DENTAL HEALTH ACTIVITY 9900 LINCOLN STREET
JBLM WA
98431
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: