| Larry Heggerness Social Purpose Professional Corporation | |
|
6720 Fort Dent Way Ste 120 Tukwila WA 98188-2580 | |
| (206) 242-4121 | |
| (206) 242-4113 |
| Full Name | Larry Heggerness Social Purpose Professional Corporation |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 6720 Fort Dent Way Ste 120, Tukwila, Washington |
| Authorized Official Name and Position | Larry K Heggerness (PRESIDENT) |
| Authorized Official Contact | 2062424121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larry Heggerness Social Purpose Professional Corporation 6720 Fort Dent Way Ste 120 Tukwila WA 98188-2580 Ph: (206) 242-4121 | Larry Heggerness Social Purpose Professional Corporation 6720 Fort Dent Way Ste 120 Tukwila WA 98188-2580 Ph: (206) 242-4121 |
| NPI Number | 1124365796 |
|---|---|
| Provider Enumeration Date | 01/15/2013 |
| Last Update Date | 01/15/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124365796 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DE00003686 (Washington) | Primary |
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