Organization
AESTHETIC AND GENERAL DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA BLIDCHENKO (RECEPTIONIST)
(253) 854-6300
Entity
Organization
Contact information
Practice address
121 KENNEBECK AVE N, KENT, WA 98030-4621
(253) 854-6300
Mailing address
121 KENNEBECK AVE N, KENT, WA 98030-4621
(253) 854-6300
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4845
WA
Other
Enumeration date
08/25/2016
Last updated
08/25/2016
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