Provider Demographics
NPI:1376746792
Name:PIERCE COLLEGE
Entity Type:Organization
Organization Name:PIERCE COLLEGE
Other - Org Name:PIERCE COLLEGE DENTAL HYGIENE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT ADMINISTRATIVE SERVI
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WISZMANN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:253-964-6506
Mailing Address - Street 1:9401 FARWEST DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1999
Mailing Address - Country:US
Mailing Address - Phone:253-964-6694
Mailing Address - Fax:253-964-6313
Practice Address - Street 1:9401 FARWEST DRIVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-1999
Practice Address - Country:US
Practice Address - Phone:253-964-6694
Practice Address - Fax:253-964-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5001565Medicaid