Healthcare Provider Details

I. General information

NPI: 1215467667
Provider Name (Legal Business Name): COMMUNITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 188TH ST S
SPANAWAY WA
98387-4618
US

IV. Provider business mailing address

1148 BROADWAY STE 100
TACOMA WA
98402-3518
US

V. Phone/Fax

Practice location:
  • Phone: 253-847-2304
  • Fax:
Mailing address:
  • Phone: 253-597-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID FLENTGE
Title or Position: CEO
Credential:
Phone: 253-597-4550