Provider Demographics
NPI:1588070601
Name:DENTAL CARE BY DESIGN
Entity type:Organization
Organization Name:DENTAL CARE BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-357-4578
Mailing Address - Street 1:5340 CORPORATE CENTER LOOP SE STE A
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5590
Mailing Address - Country:US
Mailing Address - Phone:360-357-4578
Mailing Address - Fax:360-943-4866
Practice Address - Street 1:5340 CORPORATE CENTER LOOP SE STE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5590
Practice Address - Country:US
Practice Address - Phone:360-357-4578
Practice Address - Fax:360-943-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE604835871223G0001X
WADE000058141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty