| Organization Name: | OLYMPIC DENTAL & DENTURE CENTER, LLC |
| NPI Number: | 1003148719 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD C JOHNSON (CEO) |
| Mailing Address: | 3720 6th Ave Suite A Tacoma |
| State: | WA US |
| Postal Code: | 984064938 |
| Phone Number: | 2537521320 |
| Fax Number: | 2537521425 |
| NPI Enumeration Date: | 02/04/2010 |
| NPI Last Update Date: | 02/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 416 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |