Organization
IVORY DENTURE CARE, INC.
Active
Other names
Disantis Prosthetics
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM S. DISANTIS D.D. (OWNER)
(509) 454-2273
Entity
Organization
Contact information
Practice address
210 S 11TH AVE, SUITE #45, YAKIMA, WA 98902-3293
(509) 454-2273
(509) 454-7901
Mailing address
210 S 11TH AVE, SUITE #45, YAKIMA, WA 98902-3293
(509) 454-2273
(509) 454-7901
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DN00000367
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5048293
—
WA
01
—
DN00000367
LICENSE #
WA
Enumeration date
12/28/2006
Last updated
08/22/2020
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