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General NPI Number Information
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NPI Number | 1144536079
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Entity Type | Organization
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Legal Business Name | 3-D DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 2616 YELM HWY SE STE A
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City | OLYMPIA
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State | WA
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Zip | 98501-0800
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Country | US
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Telephone | 360-352-2400
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Fax | 360-352-6255
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Provider Business Mailing Address
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Address Line | 2616 YELM HWY SE STE A
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City | OLYMPIA
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State | WA
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Zip | 98501-0800
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Country | US
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Telephone | 360-352-2400
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Fax | 360-352-6255
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Authorized Official
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Title or Position | OWNER
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Name | DR. AUSTIN R SMITH
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Credential |
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Telephone | 360-352-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 6935
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License Number State | WA
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