# MEADOWDALE DENTAL CENTER

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

## Provider details

- **NPI number:** 1689188336
- **Authorized official:** DAWN M DIVANO DDS (DENTIST)
- **Authorized official phone:** (360) 692-4705

## Contact information

- **Practice address:** 7500 OLD MILITARY RD NE STE 201, BREMERTON, WA 98311-3242
- **Practice address phone:** (360) 692-4705
- **Practice address fax:** (360) 692-4846
- **Mailing address:** 7500 OLD MILITARY RD NE STE 201, BREMERTON, WA 98311-3242
- **Mailing address phone:** (360) 692-4705
- **Mailing address fax:** (360) 692-4846

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DR00010155 | WA | Yes |

## Other

- **Enumeration date:** 11/16/2017
- **Last updated:** 11/16/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | DE00010155 | STATE LIC | WA |