Provider Demographics
NPI:1912765215
Name:DENTALL
Entity type:Organization
Organization Name:DENTALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-643-2148
Mailing Address - Street 1:10134 HALLORAN RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9366
Mailing Address - Country:US
Mailing Address - Phone:509-643-2148
Mailing Address - Fax:
Practice Address - Street 1:10134 HALLORAN RD
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:WA
Practice Address - Zip Code:98232-9366
Practice Address - Country:US
Practice Address - Phone:509-643-2148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty