Provider Demographics
NPI:1760793467
Name:RAINIER DENTAL-SUMNER
Entity Type:Organization
Organization Name:RAINIER DENTAL-SUMNER
Other - Org Name:RAINIER DENTAL-SUMNER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-891-9100
Mailing Address - Street 1:15208 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2638
Mailing Address - Country:US
Mailing Address - Phone:253-891-9100
Mailing Address - Fax:253-863-9368
Practice Address - Street 1:15208 MAIN ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2638
Practice Address - Country:US
Practice Address - Phone:253-891-9100
Practice Address - Fax:253-863-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA56291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty