| Organization Name: | A NEW IMAGE DENTURE CLINIC |
| NPI Number: | 1003237538 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETER NABEGH GHATTAS (DENTURIST) |
| Mailing Address: | 2811 E Main Puyallup |
| State: | WA US |
| Postal Code: | 983723167 |
| Phone Number: | 2537707707 |
| Fax Number: | 2537708784 |
| NPI Enumeration Date: | 12/31/2013 |
| NPI Last Update Date: | 12/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DN00000199 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |