# DENTISTRY @ RENTON

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

## Provider details

- **NPI number:** 1629718978
- **Authorized official:** BRENDA GRAY (TEAM LEADER)
- **Authorized official phone:** (253) 236-7456

## Contact information

- **Practice address:** 19221 108TH AVE SE STE 4, RENTON, WA 98055-7369
- **Practice address phone:** (253) 852-4746
- **Mailing address:** 21230 STATE ROUTE 410 E, BONNEY LAKE, WA 98391-8789
- **Mailing address phone:** (253) 236-7456

## Taxonomy

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

## Other

- **Enumeration date:** 04/01/2022
- **Last updated:** 04/26/2022