Organization · NPI-2

A New Image Denture Clinic

Denturist · Puyallup, WA

NPI number1003237538
StatusActive
Last updated in NPPESDec 31, 2013

Details

NPI
1003237538
Entity type
Organization (NPI-2)
Legal business name
A New Image Denture Clinic
Organization subpart
No
Enumeration date
Dec 31, 2013
Last updated
Dec 31, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122400000X DenturistDN00000199WAYes

Practice location

2811 E Main
Puyallup, WA 98372-3167

Phone 253-770-7707 · Fax 253-770-8784

Mailing address

2811 E Main
Puyallup, WA 98372-3167

Phone 253-770-7707 · Fax 253-770-8784

Authorized official

Peter Nabegh Ghattas
Denturist
2537707707

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