Healthcare Provider Details

I. General information

NPI: 1073664298
Provider Name (Legal Business Name): DENTURES 4 U, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 W CLEARWATER AVE SUITE 3
KENNEWICK WA
99336-1914
US

IV. Provider business mailing address

5219 W CLEARWATER AVE SUITE 3
KENNEWICK WA
99336-1914
US

V. Phone/Fax

Practice location:
  • Phone: 509-374-1660
  • Fax: 509-374-9374
Mailing address:
  • Phone: 509-374-1660
  • Fax: 509-374-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIANA S SHELBY
Title or Position: MANAGER
Credential: DPD
Phone: 509-374-1660