Provider Demographics
NPI:1548605819
Name:ANTONIO'S DENTURE SERVICES, INC.
Entity Type:Organization
Organization Name:ANTONIO'S DENTURE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-627-7751
Mailing Address - Street 1:2817 WHEATON WAY
Mailing Address - Street 2:#206
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3440
Mailing Address - Country:US
Mailing Address - Phone:360-627-7751
Mailing Address - Fax:
Practice Address - Street 1:2817 WHEATON WAY
Practice Address - Street 2:#206
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3440
Practice Address - Country:US
Practice Address - Phone:360-627-7751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000366122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty