Maenell Sullivan, Denturist DPD
Denturist in Tenino, WA. Individual provider (NPI-1).
NPI number1679675367
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1679675367
- Entity type
- Individual (NPI-1)
- Name
- Ms. Maenell Sullivan
- Credential
- Denturist DPD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 2, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122400000X | Denturist | DN361 | WA | Yes |
Practice location
296 Sussex Ave WTenino, WA 98589
Phone 360-264-5500 · Fax 360-264-5500
Mailing address
Po Box 1051Tenino, WA 98589
Phone 360-264-5500 · Fax 360-264-5500
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