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General NPI Number Information
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NPI Number | 1275098279
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Entity Type | Organization
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Legal Business Name | TANYA KUSHNER PLLC
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 10513 SILVERDALE WAY NW STE 201
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City | SILVERDALE
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State | WA
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Zip | 98383-9499
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Country | US
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Telephone | 360-779-7711
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Fax | 360-779-7732
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Provider Business Mailing Address
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Address Line | 10513 SILVERDALE WAY NW STE 201
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City | SILVERDALE
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State | WA
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Zip | 98383-9499
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Country | US
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Telephone | 360-779-7711
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Fax | 360-779-7732
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOSY LEE HAGGARD
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Credential | DO
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Telephone | 360-779-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X2210X
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Taxonomy Name | Orofacial Pain Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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