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1628 S Mildred St Suite 210 Tacoma WA 98465-1627 | |
(253) 564-1000 | |
(253) 564-0102 |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 1628 S Mildred St, Tacoma, Washington |
Authorized Official Name and Position | Manuel J La Rosa-craig (PRESIDENT) |
Authorized Official Contact | 2535641000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1628 S Mildred St Suite 210 Tacoma WA 98465-1627 Ph: (253) 564-1000 | 1628 S Mildred St Suite 210 Tacoma WA 98465-1627 Ph: (253) 564-1000 |
NPI Number | 1861604415 |
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Provider Enumeration Date | 05/04/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1861604415 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | DE8413 (Washington) | Primary |
Olympic Dental & Denture Center, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3720 6th Ave, Suite A, Tacoma, WA 98406 Phone: 253-752-1320 Fax: 253-752-1425 | |
Bansuk Ju Dds Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2302 S Union Ave Ste A6, Tacoma, WA 98405 Phone: 253-752-4422 | |