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General NPI Number Information
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NPI Number | 1700283058
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Entity Type | Organization
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Legal Business Name | DOWNTOWN DENTAL ON 4TH LLC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 1320 N 4TH AVE STE A
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City | PASCO
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State | WA
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Zip | 99301-3711
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Country | US
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Telephone | 509-540-0347
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Fax |
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Provider Business Mailing Address
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Address Line | 730 SE 8TH ST
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City | COLLEGE PLACE
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State | WA
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Zip | 99324-1646
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Country | US
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Telephone | 509-540-0347
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LANDRY BROWN
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Credential |
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Telephone | 509-540-0347
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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 | 10788
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License Number State | WA
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