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General NPI Number Information
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NPI Number | 1750704540
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Entity Type | Organization
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Legal Business Name | TACOMA DIAGNOSTIC IMAGING CENTER, LLC
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 6004 WESTGATE BLVD SUITE 210
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City | TACOMA
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State | WA
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Zip | 98406-2503
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Country | US
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Telephone | 253-752-6630
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Fax | 253-752-1173
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Provider Business Mailing Address
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Address Line | 6004 WESTGATE BLVD SUITE 210
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City | TACOMA
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State | WA
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Zip | 98406-2503
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Country | US
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Telephone | 253-752-6630
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Fax | 253-752-1173
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | MICHAEL J. GIESY
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Credential | D.M.D.
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Telephone | 253-752-6630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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