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General NPI Number Information
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NPI Number | 1548819568
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Entity Type | Organization
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Legal Business Name | WASHINGTON DENTAL CORPORATION, PC
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 12005 MERIDIAN E STE 102
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City | PUYALLUP
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State | WA
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Zip | 98373-3423
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Country | US
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Telephone | 253-214-9293
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Fax | 253-267-7368
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVE
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City | IRVINE
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State | CA
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Zip | 92614-5626
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Country | US
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Telephone | 714-845-8500
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Fax | 303-952-0892
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | DULCE GOMEZ
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Credential |
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Telephone | 714-845-8701
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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 |
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License Number State |
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