Provider Demographics
NPI:1992183339
Name:WASHINGTON DENTAL CORPORATION, PC
Entity type:Organization
Organization Name:WASHINGTON DENTAL CORPORATION, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BIENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-528-7878
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:5122 YELM HWY SE
Practice Address - Street 2:SUITE E
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5034
Practice Address - Country:US
Practice Address - Phone:360-528-7878
Practice Address - Fax:360-528-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty