| Organization Name: | BOTHELL DENTURE CLINIC, INC. |
| NPI Number: | 1245320316 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SATOMI HIRAI (LICENSED DENTURIST) |
| Mailing Address: | 10137 Main St Suite 7 Bothell |
| State: | WA US |
| Postal Code: | 980113422 |
| Phone Number: | 4254834643 |
| Fax Number: | 4254831493 |
| NPI Enumeration Date: | 10/12/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DN000258 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |