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19034 141st Street Ct E Bonney Lake WA 98391-9288 | |
| (360) 825-5585 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 19034 141st Street Ct E, Bonney Lake, Washington |
| Authorized Official Name and Position | Devin Ossman (OWNER) |
| Authorized Official Contact | 3608255585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
19034 141st Street Ct E Bonney Lake WA 98391-9288 Ph: (360) 825-5585 | 19034 141st Street Ct E Bonney Lake WA 98391-9288 Ph: (360) 825-5585 |
| NPI Number | 1841033529 |
|---|---|
| Provider Enumeration Date | 06/18/2024 |
| Last Update Date | 06/19/2024 |
| Medicare PECOS PAC ID | 1850831538 |
|---|---|
| Medicare Enrollment ID | O20240909002792 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841033529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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