Organization
EASTRIDGE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYANTHI BANTWAL D.D.S (DENTIST)
(253) 277-2620
Entity
Organization
Contact information
Practice address
24837 104TH AVE SE, 103, KENT, WA 98030-6800
(253) 277-2620
(253) 277-2659
Mailing address
24837 104TH AVE SE, 103, KENT, WA 98030-6800
(253) 277-2620
(253) 277-2659
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9467
WA
Other
Enumeration date
05/09/2014
Last updated
05/09/2014
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