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General NPI Number Information
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NPI Number | 1871615658
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Entity Type | Individual
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Provider Name | MARK J ELMORE I D.D.S.,P.S.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 803 39TH AVE SW SUITE A
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City | PUYALLUP
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State | WA
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Zip | 98373-3692
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Country | US
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Telephone | 253-841-1529
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Fax | 253-841-7853
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Provider Business Mailing Address
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Address Line | 803 39TH AVE SW SUITE A
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City | PUYALLUP
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State | WA
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Zip | 98373-3692
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Country | US
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Telephone | 253-841-1529
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Fax | 253-841-7853
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State | WA
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