# WASHINGTON DENTAL CORPORATION, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Puyallup Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548819568
- **Authorized official:** DULCE GOMEZ (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (714) 845-8701

## Contact information

- **Practice address:** 12005 MERIDIAN E STE 102, PUYALLUP, WA 98373-3423
- **Practice address phone:** (253) 214-9293
- **Practice address fax:** (253) 267-7368
- **Mailing address:** 17000 RED HILL AVE, IRVINE, CA 92614-5626
- **Mailing address phone:** (714) 845-8500
- **Mailing address fax:** (303) 952-0892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2019
- **Last updated:** 09/11/2019