| Bonney Lake Dental Llc | |
|
19410 State Route 410 E Bonney Lake WA 98391-8470 | |
| (253) 780-7003 | |
| Not Available |
| Full Name | Bonney Lake Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 19410 State Route 410 E, Bonney Lake, Washington |
| Authorized Official Name and Position | Travis Probst (OWNER /DENTIST) |
| Authorized Official Contact | 7193525773 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonney Lake Dental Llc 19410 State Route 410 E Bonney Lake WA 98391-8470 Ph: (253) 780-7003 | Bonney Lake Dental Llc 19410 State Route 410 E Bonney Lake WA 98391-8470 Ph: (253) 780-7003 |
| NPI Number | 1073088423 |
|---|---|
| Provider Enumeration Date | 10/11/2018 |
| Last Update Date | 10/11/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073088423 | NPI | - | NPPES |
| 1144431529 | Other | WA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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