# SOUTH SOUND DENTURES, P.S.

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

## Provider details

- **NPI number:** 1487974341
- **Authorized official:** MRS. HEIDI ANNE ELLIS D.H. (OWNER)
- **Authorized official phone:** (360) 709-9909

## Contact information

- **Practice address:** 1822 BLACK LAKE BLVD. SW SUITE 101, OLYMPIA, WA 98512
- **Practice address phone:** (360) 709-9909
- **Mailing address:** 1822 BLACK LAKE BLVD SW STE 101, OLYMPIA, WA 98512-5628
- **Mailing address phone:** (360) 709-9909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE10844 | WA | Yes |

## Other

- **Enumeration date:** 06/02/2010
- **Last updated:** 06/02/2010