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General NPI Number Information
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NPI Number | 1669817953
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Entity Type | Individual
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Provider Name | JOSHUA ARCHER MANCHESTER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 5630 NE 198TH PL
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City | KENMORE
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State | WA
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Zip | 98028-3113
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Country | US
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Telephone | 406-599-4642
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Fax |
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Provider Business Mailing Address
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Address Line | 11056 SE 201ST PLACE
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City | KENT
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State | WA
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Zip | 98031
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Country | US
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Telephone | 406-599-4642
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DE60579609
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License Number State | WA
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