Organization
SOUTH SOUND DENTURES, P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HEIDI ANNE ELLIS D.H. (OWNER)
(360) 709-9909
Entity
Organization
Contact information
Practice address
1822 BLACK LAKE BLVD. SW SUITE 101, OLYMPIA, WA 98512
(360) 709-9909
Mailing address
1822 BLACK LAKE BLVD SW STE 101, OLYMPIA, WA 98512-5628
(360) 709-9909
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE10844
WA
Other
Enumeration date
06/02/2010
Last updated
06/02/2010
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