MEDICARE: DR. IMRE GYARMATI D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00007457	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	911907892	OTHER		BLDC TAX ID

General Provider Information

NPI Number	:	1174509061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IMRE GYARMATI D.D.S.

Provider Business Mailing Address
First Line	:	9925 214TH AVE E
Second Line	:	SUITE A
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-3910
Country	:	US
Telephone Number	:	253-863-4594
Fax Number	:	253-863-5061

Provider Business Practice Location Address
First Line	:	9925 214TH AVE E
Second Line	:	SUITE A
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-3910
Country	:	US
Telephone Number	:	253-863-4594
Fax Number	:	253-863-5061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	01/29/2009

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