Organization
A NEW IMAGE DENTURE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER NABEGH GHATTAS D.P.D. (DENTURIST)
(253) 770-7707
Entity
Organization
Contact information
Practice address
2811 E MAIN, PUYALLUP, WA 98372-3167
(253) 770-7707
(253) 770-8784
Mailing address
2811 E MAIN, PUYALLUP, WA 98372-3167
(253) 770-7707
(253) 770-8784
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000199
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5027412
—
WA
Enumeration date
12/31/2013
Last updated
12/31/2013
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