Provider Demographics
NPI:1336522069
Name:NEW ERA DENTURE SERVICE
Entity type:Organization
Organization Name:NEW ERA DENTURE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEMENWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-496-6196
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0022
Mailing Address - Country:US
Mailing Address - Phone:360-496-6196
Mailing Address - Fax:360-496-5467
Practice Address - Street 1:209 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356
Practice Address - Country:US
Practice Address - Phone:360-496-6196
Practice Address - Fax:360-496-5467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty