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General NPI Number Information
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NPI Number | 1013381045
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Entity Type | Organization
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Legal Business Name | SOLO DENTURE AND DENTAL CLINIC INC
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 7411 196TH ST SW
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City | LYNNWOOD
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State | WA
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Zip | 98036-5052
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Country | US
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Telephone | 425-678-1166
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Fax | 425-678-1167
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Provider Business Mailing Address
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Address Line | 7924 236TH ST SW APT 300
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City | EDMONDS
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State | WA
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Zip | 98026-8838
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Country | US
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Telephone | 425-346-1604
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLEKSANDR STASYUK
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Credential | D.P.D
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Telephone | 425-346-1604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN60612122
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License Number State | WA
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