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General NPI Number Information
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NPI Number | 1679626345
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC CARE OF WA
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 2520 S 38TH ST STE A
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City | TACOMA
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State | WA
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Zip | 98409
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Country | US
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Telephone | 253-343-9133
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Fax | 253-343-9135
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Provider Business Mailing Address
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Address Line | 2520 S 38TH ST STE A
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City | TACOMA
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State | WA
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Zip | 98409
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Country | US
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Telephone | 253-343-9133
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Fax | 253-343-9135
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Authorized Official
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Title or Position | OWNER
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Name | DR. HECTOR MARTIN BUSH
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Credential | D.M.D
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Telephone | 678-432-8508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN011309
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License Number State | GA
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