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General NPI Number Information
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NPI Number | 1205249810
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Entity Type | Organization
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Legal Business Name | WASHINGTON DENTAL CORPORATION PC
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 17420 SOUTHCENTER PKWY
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City | TUKWILA
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State | WA
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Zip | 98188-3701
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Country | US
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Telephone | 253-395-5555
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Fax | 253-395-5560
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVENUE
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City | IRVINE
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State | CA
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Zip | 92614
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Country | US
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Telephone | 714-845-8890
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Fax | 949-474-1495
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN S BIENSTOCK
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Credential | DDS
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Telephone | 253-395-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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