Provider Demographics
NPI:1073664298
Name:DENTURES 4 U, PLLC
Entity Type:Organization
Organization Name:DENTURES 4 U, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPD
Authorized Official - Phone:509-374-1660
Mailing Address - Street 1:5219 W CLEARWATER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1914
Mailing Address - Country:US
Mailing Address - Phone:509-374-1660
Mailing Address - Fax:509-374-9374
Practice Address - Street 1:5219 W CLEARWATER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1914
Practice Address - Country:US
Practice Address - Phone:509-374-1660
Practice Address - Fax:509-374-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036892Medicaid