Organization
PIONEER DENTURE CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY LEE PEVNY (PRESIDENT)
(360) 659-6300
Entity
Organization
Contact information
Practice address
619 CEDAR AVE, MARYSVILLE, WA 98270-4532
(360) 659-6300
Mailing address
619 CEDAR AVE, MARYSVILLE, WA 98270-4532
(360) 659-6300
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000045
WA
Other
Enumeration date
03/02/2007
Last updated
08/22/2020
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