Individual
MITCHELL GRANT MAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2511 MERIDIAN AVE E, EDGEWOOD, WA 98371-2164
(253) 845-8817
(253) 845-6491
Mailing address
2511 MERIDIAN AVE E, EDGEWOOD, WA 98371-2164
(253) 845-8817
(253) 845-6491
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEOOOO4111
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5730809
DSHS
WA
Enumeration date
10/12/2006
Last updated
07/08/2007
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