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General NPI Number Information
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NPI Number | 1891805586
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Entity Type | Individual
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Provider Name | DONALD CHARLES PARADISE DDS
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9618 59TH AVE SW
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City | TACOMA
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State | WA
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Zip | 98498
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Country | US
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Telephone | 253-582-1570
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Fax | 253-582-2323
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Provider Business Mailing Address
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Address Line | 309 39TH AVE NE
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City | OLYMPIA
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State | WA
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Zip | 98506
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Country | US
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Telephone | 360-956-9820
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Fax | 360-357-6567
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 3596
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License Number State | WA
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