Healthcare Provider Details

I. General information

NPI: 1528757432
Provider Name (Legal Business Name): IM PROFESSIONAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 NE HOSTMARK ST STE 100A
POULSBO WA
98370-7337
US

IV. Provider business mailing address

1040 NE HOSTMARK ST
POULSBO WA
98370-7337
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-4556
  • Fax:
Mailing address:
  • Phone: 360-779-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PATRICK IM
Title or Position: OWNER
Credential: DDS
Phone: 360-779-4556