| |
737 Fawcett Ave Tacoma WA 98402-5503 | |
(253) 830-5969 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 737 Fawcett Ave, Tacoma, Washington |
Authorized Official Name and Position | David Flentge (PRESIDENT/CEO) |
Authorized Official Contact | 2535974550 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1148 Broadway Ste 100 Tacoma WA 98402-3518 Ph: (253) 597-4550 | 737 Fawcett Ave Tacoma WA 98402-5503 Ph: (253) 830-5969 |
NPI Number | 1154081966 |
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Provider Enumeration Date | 12/20/2021 |
Last Update Date | 04/29/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154081966 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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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 | |