Provider Demographics
NPI:1619411568
Name:PACIFIC DENTAL & DENTURE CLINIC,INC
Entity Type:Organization
Organization Name:PACIFIC DENTAL & DENTURE CLINIC,INC
Other - Org Name:PACIFIC DENTAL & DENTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTURIST
Authorized Official - Prefix:
Authorized Official - First Name:DUSIK
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DN00000137
Authorized Official - Phone:253-815-8500
Mailing Address - Street 1:33505 PACIFIC HWY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6809
Mailing Address - Country:US
Mailing Address - Phone:253-815-8850
Mailing Address - Fax:253-815-8501
Practice Address - Street 1:33505 PACIFIC HWY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6809
Practice Address - Country:US
Practice Address - Phone:253-815-8850
Practice Address - Fax:253-815-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental