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General NPI Number Information
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NPI Number | 1083750327
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Entity Type | Organization
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Legal Business Name | ANZI DENTAL CENTER 2
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20071 STATE ROUTE 410 E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8460
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Country | US
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Telephone | 253-447-4966
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Fax | 253-447-4968
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Provider Business Mailing Address
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Address Line | 20071 STATE ROUTE 410 E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8460
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Country | US
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Telephone | 253-447-4966
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Fax | 253-447-4968
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Authorized Official
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Title or Position | OFFICE MANAGER (CORPORATE OFFICE)
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Name | MS. ROSA MARIA CORTESI
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Credential |
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Telephone | 253-435-4401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00008264
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License Number State | WA
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