Provider Demographics
NPI:1922258037
Name:DENTURE CLINIC, INC.
Entity Type:Organization
Organization Name:DENTURE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTURIST/ PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ABEL;
Authorized Official - Last Name:VIZCARRA
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:206-365-5060
Mailing Address - Street 1:12733 LAKE CITY WAY N.E. AVE.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125
Mailing Address - Country:US
Mailing Address - Phone:206-365-5060
Mailing Address - Fax:
Practice Address - Street 1:12733 LAKE CITY WAY N.E. AVE.
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125
Practice Address - Country:US
Practice Address - Phone:206-365-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty