Organization
PT. DEFIANCE DENTAL CLINIC AND LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOFYA V KOCHUBEY (OWNER)
(253) 238-1783
Entity
Organization
Contact information
Practice address
5904 N 45TH ST, TACOMA, WA 98407-1902
(253) 238-1783
Mailing address
5904 N 45TH ST, TACOMA, WA 98407-1902
(253) 238-1783
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
WA8905
WA
122400000X
Denturist
Primary
DN60141899
WA
Other
Enumeration date
01/16/2014
Last updated
01/16/2014
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