Provider Demographics
NPI:1053636233
Name:UNIVERSITY PLACE DENTAL CLINIC
Entity Type:Organization
Organization Name:UNIVERSITY PLACE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-565-4312
Mailing Address - Street 1:7120 40TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5000
Mailing Address - Country:US
Mailing Address - Phone:253-565-4312
Mailing Address - Fax:253-565-9925
Practice Address - Street 1:7120 40TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5000
Practice Address - Country:US
Practice Address - Phone:253-565-4312
Practice Address - Fax:253-565-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000056001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty