| Panther Lake Dental | |
|
10920 Se 208th St Kent WA 98031-4009 | |
| (253) 854-1222 | |
| (253) 859-1269 |
| Full Name | Panther Lake Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10920 Se 208th St, Kent, Washington |
| Authorized Official Name and Position | Jay D Deiglmeier (PRESIDENT) |
| Authorized Official Contact | 2538541222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Panther Lake Dental 10920 Se 208th St Kent WA 98031-4009 Ph: (253) 854-1222 | Panther Lake Dental 10920 Se 208th St Kent WA 98031-4009 Ph: (253) 854-1222 |
| NPI Number | 1316010531 |
|---|---|
| Provider Enumeration Date | 11/16/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316010531 | NPI | - | NPPES |
| DE7654 | Other | WA | REGENCE |
| 5025788 | Medicaid | WA | |
| 103746 | Other | WA | L & I |
| 57064 | Other | WA | WDS |
| 5023221 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE00007064 (Washington) | Primary |
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