Full Name | |
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Speciality | Dentist |
Location | 4466 Tolt Ave, Carnation, Washington |
Authorized Official Name and Position | Trevor Tsuchikawa (MEMBER) |
Authorized Official Contact | 4253334101 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 909 Carnation WA 98014-0909 Ph: (425) 333-4101 | 4466 Tolt Ave Carnation WA 98014 Ph: (425) 333-4101 |
NPI Number | 1548566433 |
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Provider Enumeration Date | 02/10/2011 |
Last Update Date | 02/10/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1548566433 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 60035945 (Washington) | Primary |