Provider Demographics
NPI:1467577551
Name:UPSHUR & MIRMNONSEF D.D.S., P.S.
Entity Type:Organization
Organization Name:UPSHUR & MIRMNONSEF D.D.S., P.S.
Other - Org Name:SOUND CHOICE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONWAY
Authorized Official - Middle Name:LITTLETON
Authorized Official - Last Name:UPSHUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-858-3457
Mailing Address - Street 1:7116 STINSON AVE STE B315
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1100
Mailing Address - Country:US
Mailing Address - Phone:253-858-3457
Mailing Address - Fax:253-853-4265
Practice Address - Street 1:7116 STINSON AVE STE B315
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1100
Practice Address - Country:US
Practice Address - Phone:253-858-3457
Practice Address - Fax:253-853-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000093651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty