Provider Demographics
NPI:1326334178
Name:EAST TACOMA DENTAL PLLC
Entity Type:Organization
Organization Name:EAST TACOMA DENTAL PLLC
Other - Org Name:COMFORT DENTAL EAST TACOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PROBST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-472-3006
Mailing Address - Street 1:3820 PACIFIC AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7825
Mailing Address - Country:US
Mailing Address - Phone:253-472-3006
Mailing Address - Fax:253-472-3011
Practice Address - Street 1:3820 PACIFIC AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7825
Practice Address - Country:US
Practice Address - Phone:253-472-3006
Practice Address - Fax:253-472-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60178653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty