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Organization

BONNEY LAKE DENTAL LLC

Active
Other names
Comfort Dental Bonney Lake
Organization subpart
No

Provider details

NPI number
Authorized official
TRAVIS PROBST DDS (OWNER /DENTIST)
(719) 352-5773
Entity
Organization

Contact information

Practice address
19410 STATE ROUTE 410 E, BONNEY LAKE, WA 98391-8470
(253) 780-7003
Mailing address
19410 STATE ROUTE 410 E, BONNEY LAKE, WA 98391-8470
(253) 780-7003

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1144431529
NPI
WA
Enumeration date
10/11/2018
Last updated
10/11/2018
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