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5003 Tacoma Mall Blvd Ste 103 Tacoma WA 98409-7120 | |
(253) 759-3366 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 5003 Tacoma Mall Blvd Ste 103, Tacoma, Washington |
Authorized Official Name and Position | Dale Vanderschelden (OWNER) |
Authorized Official Contact | 2537593366 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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5003 Tacoma Mall Blvd Ste 103 Tacoma WA 98409-7120 Ph: (253) 759-3366 | 5003 Tacoma Mall Blvd Ste 103 Tacoma WA 98409-7120 Ph: (253) 759-3366 |
NPI Number | 1730543240 |
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Provider Enumeration Date | 04/11/2016 |
Last Update Date | 04/11/2016 |
Identifier | Type | State | Issuer |
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1730543240 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | DE00005629 (Washington) | Primary |
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