Organization
DREW MALIDORE, D.D.S., P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DREWETT G MALIDORE DDS (OWNER)
(360) 871-0788
Entity
Organization
Contact information
Practice address
6500 SE MILE HILL DR, PORT ORCHARD, WA 98366-8724
(360) 871-0788
(360) 871-6976
Mailing address
6500 SE MILE HILL DR, PORT ORCHARD, WA 98366-8724
(360) 871-0788
(360) 871-6976
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7770
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1408327
UNITED CONCORDIA
—
05
—
5040076
—
WA
01
—
59239
WDS
—
Enumeration date
10/11/2007
Last updated
05/22/2012
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