Full Name | |
---|---|
Speciality | Dentist |
Location | 14818 Pacific Ave, Tacoma, Washington |
Authorized Official Name and Position | Carl Larue Knox (OWNER) |
Authorized Official Contact | 2535310638 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
14818 Pacific Ave Tacoma WA 98444 Ph: (253) 531-0638 | 14818 Pacific Ave Tacoma WA 98444 Ph: (253) 531-0638 |
NPI Number | 1487784013 |
---|---|
Provider Enumeration Date | 03/06/2007 |
Last Update Date | 06/13/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487784013 | NPI | - | NPPES |
0143 | Other | WASHINGTON DENTAL SERVICE | |
614482 | Other | UNITED CONCORDIA INSURANC | |
129840361 | Other | AMERICAN DENTAL ASSOCIATI | |
5092507 | Medicaid | WA | |
KN7070 | Other | REGENCE BLUE CROSS BLUE S |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 5943 (Washington) | Primary |
Olympic Dental & Denture Center, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3720 6th Ave, Suite A, Tacoma, WA 98406 Phone: 253-752-1320 Fax: 253-752-1425 | |
Bansuk Ju Dds Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2302 S Union Ave Ste A6, Tacoma, WA 98405 Phone: 253-752-4422 | |