Provider Demographics
NPI:1780131342
Name:ADRIAN TOMARERE DENTAL
Entity type:Organization
Organization Name:ADRIAN TOMARERE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:TOMARERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-689-2557
Mailing Address - Street 1:11 HOSPITAL WAY
Mailing Address - Street 2:BOX 278
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812
Mailing Address - Country:US
Mailing Address - Phone:509-689-2557
Mailing Address - Fax:509-689-3179
Practice Address - Street 1:11 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812
Practice Address - Country:US
Practice Address - Phone:509-689-2557
Practice Address - Fax:509-689-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1223G0001XOtherDENTAL