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Organization

COSTA & DAGEENAKIS FAMILY DENTISTRY PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MICHELLE D RICHARDSON (TREATMENT COORDINATOR)
(360) 876-0550
Entity
Organization

Contact information

Practice address
1565 WOODRIDGE DR SE, STE A, PORT ORCHARD, WA 98366
(360) 876-0550
(360) 876-0861
Mailing address
1565 WOODRIDGE DR SE, STE A, PORT ORCHARD, WA 98366
(360) 876-0550
(360) 876-0861

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
7181
WA
122300000X
Dentist
Primary
9302
WA
122300000X
Dentist
DE00009872
WA

Other

Enumeration date
09/07/2006
Last updated
08/22/2020
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