# PUYALLUP DENTAL, LLC

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

## Provider details

- **NPI number:** 1992059737
- **Authorized official:** DR. TRAVIS JOHN PROBST D.D.S. (DENTIST)
- **Authorized official phone:** (253) 475-9120

## Contact information

- **Practice address:** 16420 MERIDIAN E, PUYALLUP, WA 98375-2514
- **Practice address phone:** (253) 475-9120
- **Practice address fax:** (253) 475-9284
- **Mailing address:** 16420 MERIDIAN E, PUYALLUP, WA 98375-2514
- **Mailing address phone:** (253) 475-9120
- **Mailing address fax:** (253) 475-9284

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE 60198294 | WA | Yes |

## Other

- **Enumeration date:** 11/01/2012
- **Last updated:** 11/01/2012