# KORSMO & HENRY DDD PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Puyallup Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891158317
- **Authorized official:** TAMARA ROSARIO (OFFICE MANAGER)
- **Authorized official phone:** (253) 770-0529

## Contact information

- **Practice address:** 5620 112TH ST E, SUITE 250, PUYALLUP, WA 98373-3206
- **Practice address phone:** (253) 770-0529
- **Practice address fax:** (253) 770-9638
- **Mailing address:** 5620 112TH ST E, SUITE 250, PUYALLUP, WA 98373-3206
- **Mailing address phone:** (253) 770-0529
- **Mailing address fax:** (253) 770-9638

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5254 | WA | Yes |

## Other

- **Enumeration date:** 04/01/2016
- **Last updated:** 04/01/2016