Organization
MEADOWDALE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN M DIVANO DDS (DENTIST)
(360) 692-4705
Entity
Organization
Contact information
Practice address
7500 OLD MILITARY RD NE STE 201, BREMERTON, WA 98311-3242
(360) 692-4705
(360) 692-4846
Mailing address
7500 OLD MILITARY RD NE STE 201, BREMERTON, WA 98311-3242
(360) 692-4705
(360) 692-4846
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DR00010155
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE00010155
STATE LIC
WA
Enumeration date
11/16/2017
Last updated
11/16/2017
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