Provider Demographics
NPI:1497470181
Name:IM PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:IM PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-779-4556
Mailing Address - Street 1:1040 NE HOSTMARK ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7337
Mailing Address - Country:US
Mailing Address - Phone:360-779-4556
Mailing Address - Fax:360-779-1212
Practice Address - Street 1:1040 NE HOSTMARK ST STE 100A
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7337
Practice Address - Country:US
Practice Address - Phone:360-779-4556
Practice Address - Fax:360-779-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental