| Bruchal Orthodontics | |
|
12900 Ne 180th St Ste 215 Bothell WA 98011-5773 | |
| (425) 939-8428 | |
| (425) 939-8418 |
| Full Name | Bruchal Orthodontics |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12900 Ne 180th St Ste 215, Bothell, Washington |
| Authorized Official Name and Position | Trina Marie Bruchal (OWNER/ORTHODONTIST) |
| Authorized Official Contact | 4259398428 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruchal Orthodontics 12900 Ne 180th St Ste 215 Bothell WA 98011-5773 Ph: (425) 939-8428 | Bruchal Orthodontics 12900 Ne 180th St Ste 215 Bothell WA 98011-5773 Ph: (425) 939-8428 |
| NPI Number | 1033411053 |
|---|---|
| Provider Enumeration Date | 11/23/2010 |
| Last Update Date | 12/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033411053 | NPI | - | NPPES |
| 1023208501 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DE00010886 (Washington) | Primary |
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