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General NPI Number Information
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NPI Number | 1518237221
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Entity Type | Organization
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Legal Business Name | WEST TACOMA DENTAL LLC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 2501 N PEARL ST
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City | TACOMA
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State | WA
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Zip | 98406-2540
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Country | US
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Telephone | 253-752-6349
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 N PEARL ST
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City | TACOMA
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State | WA
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Zip | 98406-2540
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Country | US
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Telephone | 253-752-6349
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL DAVID CROSSEN
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Credential | DMD
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Telephone | 253-752-6349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60235923
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License Number State | WA
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