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General NPI Number Information
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NPI Number | 1366691677
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Entity Type | Organization
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Legal Business Name | SIXTH AVENUE DENTURE CENTER, PLLC
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 1217 6TH AVE
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City | TACOMA
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State | WA
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Zip | 98405-4004
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Country | US
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Telephone | 253-627-8178
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Fax | 253-627-5853
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Provider Business Mailing Address
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Address Line | 1217 6TH AVE
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City | TACOMA
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State | WA
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Zip | 98405-4004
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Country | US
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Telephone | 253-627-8178
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Fax | 253-627-5853
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CINDY J REED
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Credential |
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Telephone | 253-627-8178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | DN0000473
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License Number State | WA
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