Provider Demographics
NPI:1790762045
Name:MIDTOWN DENTAL CLINIC, PS INC
Entity Type:Organization
Organization Name:MIDTOWN DENTAL CLINIC, PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ZWEIFEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-946-1678
Mailing Address - Street 1:750 GEORGE WASHINGTON WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4247
Mailing Address - Country:US
Mailing Address - Phone:509-946-1678
Mailing Address - Fax:509-946-7500
Practice Address - Street 1:750 GEORGE WASHINGTON WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4247
Practice Address - Country:US
Practice Address - Phone:509-946-1678
Practice Address - Fax:509-946-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5034129Medicaid