Healthcare Provider Details

I. General information

NPI: 1659230076
Provider Name (Legal Business Name): DUFFIN DENTAL CORP, 111 DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LEBER ST. NE
ORTING WA
98360
US

IV. Provider business mailing address

PO BOX 69
ORTING WA
98360-0069
US

V. Phone/Fax

Practice location:
  • Phone: 360-893-9214
  • Fax: 360-893-9216
Mailing address:
  • Phone: 360-893-9214
  • Fax: 360-893-9216

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: DR. JAMES LEE DUFFIN
Title or Position: PRESIDENT DUFFIN DENTAL CORP
Credential: DDS
Phone: 253-677-9012