Provider Demographics
NPI:1245359926
Name:DISCOVERY DENTURE CENTER, INC.
Entity type:Organization
Organization Name:DISCOVERY DENTURE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-943-6290
Mailing Address - Street 1:1700 COOPER POINT RD SW STE B3
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1110
Mailing Address - Country:US
Mailing Address - Phone:360-943-6290
Mailing Address - Fax:360-943-8505
Practice Address - Street 1:1700 COOPER POINT RD SW STE B3
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1110
Practice Address - Country:US
Practice Address - Phone:360-943-6290
Practice Address - Fax:360-943-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5040498Medicaid
WA5028626Medicaid
WA5021563Medicaid