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10725 Se 256th St Ste 1 Kent WA 98030-8285 | |
| (253) 854-2714 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10725 Se 256th St Ste 1, Kent, Washington |
| Authorized Official Name and Position | Manpreet Dhaliwal (OWNER) |
| Authorized Official Contact | 2538542714 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10725 Se 256th St Ste 1 Kent WA 98030-8285 Ph: (253) 854-2714 | 10725 Se 256th St Ste 1 Kent WA 98030-8285 Ph: (253) 854-2714 |
| NPI Number | 1750834883 |
|---|---|
| Provider Enumeration Date | 07/25/2016 |
| Last Update Date | 07/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750834883 | NPI | - | NPPES |
| 2024505 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE60243483 (Washington) | Primary |
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