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General NPI Number Information
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NPI Number | 1245583806
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Entity Type | Organization
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Legal Business Name | WEST PASCO FAMILY DENTAL-COURT ST., LLC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 1506 N ROAD 40
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City | PASCO
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State | WA
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Zip | 99301-2615
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Country | US
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Telephone | 509-547-9956
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 N ROAD 40
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City | PASCO
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State | WA
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Zip | 99301-2615
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Country | US
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Telephone | 509-547-9956
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREG WILLIAM FRODEL
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Credential | D.D.S
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Telephone | 509-547-9956
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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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