Organization
PACIFIC HIGHWAY DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES HENRY PAN D.D.S. (PRESIDENT)
(253) 529-9434
Entity
Organization
Contact information
Practice address
27020 PACIFIC HWY S, SUITE C, KENT, WA 98032-6951
(253) 529-9434
Mailing address
27020 PACIFIC HWY S, SUITE C, KENT, WA 98032-6951
(253) 529-9434
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00007305
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5022967
—
WA
Enumeration date
04/29/2010
Last updated
04/29/2010
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