Organization
SUMMIT DENTAL LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN BURLESON CDT (OWNER-DENTAL LAB)
(360) 871-2444
Entity
Organization
Contact information
Practice address
1590 WOODRIDGE DR SE, PORT ORCHARD, WA 98366-3818
(360) 871-2444
Mailing address
4782 RUTHERFORD CIR SW, PORT ORCHARD, WA 98367-6430
(360) 876-0238
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
603128257
WA
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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