# MOBILE DENTAL NORTHWEST, LLC

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

## Provider details

- **NPI number:** 1700148152
- **Authorized official:** DR. GREGORY ROBERT FISHER DDS (VICE PRESIDENT- FINANCE)
- **Authorized official phone:** (253) 432-4795

## Contact information

- **Practice address:** 1622 S MILDRED ST, SUITE B, TACOMA, WA 98465-1610
- **Practice address phone:** (253) 432-4795
- **Mailing address:** 1622 S MILDRED ST, SUITE B, TACOMA, WA 98465-1610
- **Mailing address phone:** (253) 432-4795

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4923 | WA | Yes |

## Other

- **Enumeration date:** 06/12/2012
- **Last updated:** 06/12/2012