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General NPI Number Information
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NPI Number | 1023376225
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Entity Type | Organization
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Legal Business Name | JS DENTAL CLINIC, LLC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 9735 S 222ND ST
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City | KENT
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State | WA
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Zip | 98031-2410
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Country | US
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Telephone | 206-661-0520
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Fax |
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Provider Business Mailing Address
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Address Line | 9735 S 222ND ST
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City | KENT
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State | WA
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Zip | 98031-2410
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Country | US
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Telephone | 206-661-0520
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Fax |
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Authorized Official
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Title or Position | DENTURIST
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Name | LOLITA GUEVARRA SANTOS
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Credential | DENTURIST
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Telephone | 206-661-0520
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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 | 603197556
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License Number State | WA
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