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General NPI Number Information
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NPI Number | 1902078421
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Entity Type | Organization
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Legal Business Name | SPECKHARDTS DENTAL LAB INC
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 219 4TH AVE SE
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City | PUYALLUP
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State | WA
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Zip | 98372
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Country | US
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Telephone | 253-845-7001
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Fax | 253-770-6212
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | PUYALLUP
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State | WA
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Zip | 98371
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Country | US
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Telephone | 253-845-7001
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Fax | 253-770-6212
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TOM T SPECKHARDT
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Credential | LD
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Telephone | 253-845-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | DN00000132
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License Number State | WA
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