| Organization Name: | SPECKHARDTS DENTAL LAB INC |
| NPI Number: | 1902078421 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TOM T SPECKHARDT (PRESIDENT) |
| Mailing Address: | 219 4th Ave Se Puyallup |
| State: | WA US |
| Postal Code: | 98372 |
| Phone Number: | 2538457001 |
| Fax Number: | 2537706212 |
| NPI Enumeration Date: | 03/25/2008 |
| NPI Last Update Date: | 03/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DN00000132 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |