Provider Demographics
NPI:1699599324
Name:DENTURE DESIGN STUDIO, PLLC
Entity type:Organization
Organization Name:DENTURE DESIGN STUDIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-303-9090
Mailing Address - Street 1:7233 W DESCHUTES AVE STE E
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6707
Mailing Address - Country:US
Mailing Address - Phone:509-529-1469
Mailing Address - Fax:
Practice Address - Street 1:1298 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-9727
Practice Address - Country:US
Practice Address - Phone:509-529-1469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty