Organization Name: | EVERETT DENTURE CENTER PLLC |
NPI Number: | 1174840896 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK CHESLIK (OWNER) |
Mailing Address: | 4367 Rucker Ave Everett |
State: | WA US |
Postal Code: | 982032213 |
Phone Number: | 4252592800 |
Fax Number: | 4252592800 |
NPI Enumeration Date: | 04/21/2010 |
NPI Last Update Date: | 04/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | DN00000342 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |