| NPI | 1962916379 |
|---|---|
| Former Legal Business Name | PROFESSIONAL DENTURE CLINIC |
| Entity Type | Organization |
| Authorized Contact | JONATHAN MUNGER DICKSON Doctor/Owner 253-230-8084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 60292621) |
| Additional Taxonomies | 122400000X Denturist (Licence: WA 60772847) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2017-12-07 |