|
| |
|
10217 125th Street Ct E Fl 3 Puyallup WA 98374-2761 | |
| (253) 864-4760 | |
| (253) 864-4766 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 10217 125th Street Ct E Fl 3, Puyallup, Washington |
| Authorized Official Name and Position | Mary Bartolo (DEPUTY DIRECTOR) |
| Authorized Official Contact | 2067883224 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 34703 Seattle WA 98124-1703 Ph: () - | 10217 125th Street Ct E Fl 3 Puyallup WA 98374-2761 Ph: (253) 864-4760 |
| NPI Number | 1528116480 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528116480 | NPI | - | NPPES |
| 1012573 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6005372781 (Washington) | Primary |
Levi Reynolds Dds Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2921 5th Ave Ne Ste 110, Puyallup, WA 98372 Phone: 253-841-3173 | |
Kim D Nordberg Dds, Ps Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11023 Canyon Rd E, Puyallup, WA 98373 Phone: 253-535-6666 Fax: 253-535-5432 | |
Paula Stepp Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 15614 Meridian E Ste 400, Puyallup, WA 98375 Phone: 618-363-6496 | |
George G. Ghosn D.d.s.,p.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 604 S Meridian, Puyallup, WA 98371 Phone: 253-845-7911 Fax: 253-845-1475 |