MEDICARE: NORTHWEST CENTER FOR PROSTHODONTICS

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	1223P0700X	Prosthodontics	DE60579609	WA

General Provider Information

NPI Number	:	1548779515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST CENTER FOR PROSTHODONTICS

Provider Business Mailing Address
First Line	:	3425 ENSIGN RD NE STE 210
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5063
Country	:	US
Telephone Number	:	406-599-4642
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 ENSIGN RD NE STE 210
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5063
Country	:	US
Telephone Number	:	406-599-4642
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	JOSHUA A MANCHESTER
Credential	:	DDS, MSD
Telephone Number	:	406-599-4642

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	07/21/2022

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Directions to “NORTHWEST CENTER FOR PROSTHODONTICS ” Practice Location

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