Organization
MOBILE DENTAL NORTHWEST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY ROBERT FISHER DDS (VICE PRESIDENT- FINANCE)
(253) 432-4795
Entity
Organization
Contact information
Practice address
1622 S MILDRED ST, SUITE B, TACOMA, WA 98465-1610
(253) 432-4795
Mailing address
1622 S MILDRED ST, SUITE B, TACOMA, WA 98465-1610
(253) 432-4795
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4923
WA
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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