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General NPI Number Information
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NPI Number | 1750409827
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Entity Type | Organization
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Legal Business Name | OLYMPIC DENTAL & DENTURE CENTER,LLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 3720 6TH AVE STE A
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City | TACOMA
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State | WA
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Zip | 98406-4938
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Country | US
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Telephone | 253-752-1320
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Fax | 253-752-1425
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Provider Business Mailing Address
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Address Line | 3720 6TH AVE STE A
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City | TACOMA
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State | WA
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Zip | 98406-4938
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Country | US
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Telephone | 253-752-1320
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Fax | 253-752-1425
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHARD C JOHNSON
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Credential | LD
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Telephone | 253-752-1320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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