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General NPI Number Information
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NPI Number | 1356811319
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Entity Type | Organization
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Legal Business Name | MC-PULL LLC
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 1410 SE BISHOP BLVD
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City | PULLMAN
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State | WA
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Zip | 99163-5419
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Country | US
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Telephone | 509-339-6511
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Fax | 509-339-6735
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Provider Business Mailing Address
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Address Line | PO BOX 19187
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City | SPOKANE
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State | WA
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Zip | 99219-9187
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Country | US
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Telephone | 509-235-2900
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Fax | 509-235-2925
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CATHY M REED
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Credential |
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Telephone | 509-235-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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