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General NPI Number Information
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NPI Number | 1023252947
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Entity Type | Organization
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Legal Business Name | PACIFIC NORTHWEST ORTHODONTICS
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 2702 S 42ND ST STE 106
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City | TACOMA
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State | WA
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Zip | 98409-7315
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Country | US
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Telephone | 253-472-7788
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Fax | 253-474-9253
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Provider Business Mailing Address
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Address Line | 2702 S 42ND ST STE 106
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City | TACOMA
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State | WA
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Zip | 98409-7315
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Country | US
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Telephone | 253-472-7788
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Fax | 253-474-9253
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Authorized Official
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Title or Position | OWNER
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Name | BRENT HASSEL
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Credential | DDS, PS
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Telephone | 253-472-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE00007215
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License Number State | WA
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