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General NPI Number Information
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NPI Number | 1942611157
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Entity Type | Organization
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Legal Business Name | MARK SCHUTTE D.D.S. PLLC
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 6225 BURDEN BLVD
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City | PASCO
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State | WA
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Zip | 99301
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Country | US
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Telephone | 509-547-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2527
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City | PASCO
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State | WA
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Zip | 99302-2527
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Country | US
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Telephone | 509-989-3692
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK BRANDON SCHUTTE
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Credential | DDS
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Telephone | 509-547-3000
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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 | DE60106594
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License Number State | WA
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