| Pt. Defiance Dental Clinic And Lab | |
|
5904 N 45th St Tacoma WA 98407-1902 | |
| (253) 238-1783 | |
| Not Available |
| Full Name | Pt. Defiance Dental Clinic And Lab |
|---|---|
| Speciality | Denturist |
| Location | 5904 N 45th St, Tacoma, Washington |
| Authorized Official Name and Position | Sofya V Kochubey (OWNER) |
| Authorized Official Contact | 2532381783 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pt. Defiance Dental Clinic And Lab 5904 N 45th St Tacoma WA 98407-1902 Ph: (253) 238-1783 | Pt. Defiance Dental Clinic And Lab 5904 N 45th St Tacoma WA 98407-1902 Ph: (253) 238-1783 |
| NPI Number | 1467874917 |
|---|---|
| Provider Enumeration Date | 01/16/2014 |
| Last Update Date | 01/16/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467874917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | WA8905 (Washington) | Secondary |
| 122400000X | Denturist | DN60141899 (Washington) | Primary |
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