| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 419 S 4th St, Renton, Washington |
| Authorized Official Name and Position | Paul A Chilton (OWNER) |
| Authorized Official Contact | 4252717740 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
419 S 4th St Renton WA 98055-2541 Ph: (425) 271-7740 | 419 S 4th St Renton WA 98055-2541 Ph: (425) 271-7740 |
| NPI Number | 1356560593 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356560593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 6348 (Washington) | Primary |
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