| Great Wall Clinic | |
|
18230 E Valley Hwy 168 Kent WA 98032-1259 | |
| (425) 656-9025 | |
| Not Available |
| Full Name | Great Wall Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 18230 E Valley Hwy, Kent, Washington |
| Authorized Official Name and Position | Ephraim Rollolazo (OFFICE MANAGER) |
| Authorized Official Contact | 4256569025 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Wall Clinic 18230 E Valley Hwy 168 Kent WA 98032-1259 Ph: () - | Great Wall Clinic 18230 E Valley Hwy 168 Kent WA 98032-1259 Ph: (425) 656-9025 |
| NPI Number | 1184952079 |
|---|---|
| Provider Enumeration Date | 12/03/2009 |
| Last Update Date | 12/03/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184952079 | NPI | - | NPPES |
| 5034616 | Other | WA | DSHS PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DE00007365 (Washington) | Primary |
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