Provider Demographics
NPI:1972839488
Name:BELLINGHAM DENTURE CLINIC, INC
Entity Type:Organization
Organization Name:BELLINGHAM DENTURE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTURIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SULEK
Authorized Official - Suffix:
Authorized Official - Credentials:DN - DENTURIST
Authorized Official - Phone:360-305-9734
Mailing Address - Street 1:1329 KING STREET
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229
Mailing Address - Country:US
Mailing Address - Phone:360-647-0395
Mailing Address - Fax:360-594-4387
Practice Address - Street 1:1329 KING STREET
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229
Practice Address - Country:US
Practice Address - Phone:360-647-0395
Practice Address - Fax:360-594-4387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000395122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty