Provider Demographics
NPI:1457798092
Name:DENT KORSMO & HENRY D.D.S., P.S.
Entity Type:Organization
Organization Name:DENT KORSMO & HENRY D.D.S., P.S.
Other - Org Name:PARKLAND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-537-4011
Mailing Address - Street 1:12165 PACIFIC AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444
Mailing Address - Country:US
Mailing Address - Phone:253-537-4011
Mailing Address - Fax:253-537-2939
Practice Address - Street 1:12165 PACIFIC AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444
Practice Address - Country:US
Practice Address - Phone:253-537-4011
Practice Address - Fax:253-537-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty