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Organization
THE PROFESSIONAL DENTURE CENTER
Active
Organization
THE PROFESSIONAL DENTURE CENTER
Active
Other names
Professional Denture Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN MUNGER DICKSON DMD (DOCTOR/OWNER)
(253) 230-8084
Entity
Organization
Contact information
Practice address
835 E COLONIAL AVE STE 103, MOSES LAKE, WA 98837-4617
(509) 707-0707
Mailing address
835 E COLONIAL AVE STE 103, MOSES LAKE, WA 98837-4617
(509) 707-0707
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
60292621
WA
122400000X
Denturist
60772847
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2059589
—
WA
Enumeration date
11/21/2017
Last updated
03/17/2025
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