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General NPI Number Information
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NPI Number | 1467577551
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Entity Type | Organization
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Legal Business Name | UPSHUR & MIRMNONSEF D.D.S., P.S.
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7116 STINSON AVE STE B315
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City | GIG HARBOR
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State | WA
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Zip | 98335-1100
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Country | US
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Telephone | 253-858-3457
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Fax | 253-853-4265
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Provider Business Mailing Address
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Address Line | 7116 STINSON AVE STE B315
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City | GIG HARBOR
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State | WA
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Zip | 98335-1100
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Country | US
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Telephone | 253-858-3457
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Fax | 253-853-4265
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CONWAY LITTLETON UPSHUR
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Credential | DDS
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Telephone | 253-858-3457
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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 | DE00009365
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License Number State | WA
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