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General NPI Number Information
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NPI Number | 1871015040
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Entity Type | Organization
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Legal Business Name | AGATA A PIKULA DDS PLLC
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1420 3RD ST SE # 104
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City | PUYALLUP
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State | WA
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Zip | 98372-3730
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Country | US
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Telephone | 253-697-0201
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Fax | 253-697-0399
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Provider Business Mailing Address
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Address Line | 1420 3RD ST SE # 104
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City | PUYALLUP
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State | WA
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Zip | 98372-3730
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Country | US
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Telephone | 253-697-0201
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AGATA AGNIESZKA PIKULA
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Credential | DDS
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Telephone | 253-697-0201
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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 | DE60591198
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License Number State | WA
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