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General NPI Number Information
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NPI Number | 1962708651
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Entity Type | Organization
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Legal Business Name | STEVEN S. BROUGHTON D.D.S. DENTAL OF UNIVERSITY PLACE PLLC
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 6706 24TH ST W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-5460
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Country | US
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Telephone | 253-565-1145
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Fax | 253-565-5228
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Provider Business Mailing Address
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Address Line | 6706 24TH ST W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-5460
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Country | US
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Telephone | 253-565-1145
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Fax | 253-565-5228
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DARCY M KANAR
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Credential |
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Telephone | 253-565-1145
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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 | 7977
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License Number State | WA
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