| Everlast Family Dental Clinic | |
|
1212 S 11th St Ste 47 Tacoma WA 98405-4021 | |
| (253) 573-0070 | |
| (253) 573-0272 |
| Full Name | Everlast Family Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1212 S 11th St Ste 47, Tacoma, Washington |
| Authorized Official Name and Position | Eun J. Pyeun-kim (OWNER) |
| Authorized Official Contact | 2535730070 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Everlast Family Dental Clinic 1212 S 11th St Ste 47 Tacoma WA 98405-4021 Ph: (253) 573-0070 | Everlast Family Dental Clinic 1212 S 11th St Ste 47 Tacoma WA 98405-4021 Ph: (253) 573-0070 |
| NPI Number | 1770809832 |
|---|---|
| Provider Enumeration Date | 04/14/2010 |
| Last Update Date | 04/14/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770809832 | NPI | - | NPPES |
| 5056478 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DE00010831 (Washington) | Primary |
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