Individual
MEVADEE PIBULNIYOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
5005 MAIN ST STE 107, TACOMA, WA 98407-3177
(253) 262-0024
Mailing address
5005 MAIN ST STE 107, TACOMA, WA 98407-3177
(253) 262-0024
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
61668744
WA
Other
Enumeration date
08/23/2025
Last updated
08/23/2025
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