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General NPI Number Information
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NPI Number | 1760543292
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Entity Type | Organization
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Legal Business Name | CENTER FOR ENDODONTIC CARE INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 22613 PACIFIC HWY S STE 301
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City | DES MOINES
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State | WA
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Zip | 98198-5110
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Country | US
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Telephone | 206-824-7000
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Fax | 206-824-4888
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Provider Business Mailing Address
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Address Line | 22613 PACIFIC HWY S STE 301 #A
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City | DES MOINES
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State | WA
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Zip | 98198-5110
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Country | US
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Telephone | 206-824-7000
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Fax | 206-824-4888
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Authorized Official
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Title or Position | DDS MDS
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Name | MR. KULWANT S VERRAICH
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Credential |
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Telephone | 206-824-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 008393
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License Number State | WA
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