Organization Name: | LANCE TIMMERMAN DMDPS |
NPI Number: | 1033542725 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LANCE BRANDON TIMMERMAN (DENTIST/OWNER) |
Mailing Address: | 7100 Fort Dent Way Suite #270 Tukwila |
State: | WA US |
Postal Code: | 981887500 |
Phone Number: | 2062415533 |
Fax Number: | 2062415538 |
NPI Enumeration Date: | 08/16/2013 |
NPI Last Update Date: | 08/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |