Provider Demographics
NPI:1962708651
Name:STEVEN S. BROUGHTON D.D.S. DENTAL OF UNIVERSITY PLACE PLLC
Entity type:Organization
Organization Name:STEVEN S. BROUGHTON D.D.S. DENTAL OF UNIVERSITY PLACE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-565-1145
Mailing Address - Street 1:6706 24TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5460
Mailing Address - Country:US
Mailing Address - Phone:253-565-1145
Mailing Address - Fax:253-565-5228
Practice Address - Street 1:6706 24TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5460
Practice Address - Country:US
Practice Address - Phone:253-565-1145
Practice Address - Fax:253-565-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty