Organization
TENINO DENTURE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAENELL SULLIVAN (MEMBER)
(360) 264-5500
Entity
Organization
Contact information
Practice address
296 SUSSEX AVE W, TENINO, WA 98589-9360
(360) 264-5500
Mailing address
PO BOX 1051, TENINO, WA 98589-1051
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN000361WA
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679675367
NPI TYPE I
WA
05
—
5045273
—
WA
01
—
DN000361WA
PROFESSIONAL LICENSE
WA
Enumeration date
04/10/2013
Last updated
04/10/2013
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