# MAPLE VALLEY DENTISTRY PROFESSIONALS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023338522
- **Authorized official:** DR. BERNARDO EZEQUIEL TAINA D.D.S (PRESIDENT)
- **Authorized official phone:** (425) 433-0600

## Contact information

- **Practice address:** 24015 SE KENT KANGLEY RD, SUITE C, MAPLE VALLEY, WA 98038-6802
- **Practice address phone:** (425) 433-0600
- **Practice address fax:** (425) 433-0877
- **Mailing address:** 24015 SE KENT KANGLEY RD, SUITE C, MAPLE VALLEY, WA 98038-6802
- **Mailing address phone:** (425) 433-0600
- **Mailing address fax:** (425) 433-0877

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00009306 | WA | Yes |

## Other

- **Enumeration date:** 06/07/2010
- **Last updated:** 04/15/2022