Federal Way Dental Clinic
Preferred Provider Organization in Federal Way, WA. Organization (NPI-2).
NPI number1760936637
StatusActive
Last updated in NPPESAug 9, 2016
Details
- NPI
- 1760936637
- Entity type
- Organization (NPI-2)
- Legal business name
- Federal Way Dental Clinic
- Organization subpart
- No
- Enumeration date
- Aug 9, 2016
- Last updated
- Aug 9, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 305R00000X | Preferred Provider Organization | de00009186 | WA | Yes |
Practice location
2016 S 320th StSuite F
Federal Way, WA 98003-5453
Phone 253-839-8106 · Fax 253-941-7989
Mailing address
2016 S 320th StSuite F
Federal Way, WA 98003-5453
Phone 253-839-8106 · Fax 253-941-7989
Authorized official
Yong K Park
Owner
2538398106
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