A New Image Denture Clinic
Organization Active NPI Denturist · Puyallup, WA
NPI 1003237538 · NPPES record last updated Dec 31, 2013
Key facts
- NPI
- 1003237538
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Denturist 122400000X
- License
- DN00000199 (WA)
- Legal business name
- A NEW IMAGE DENTURE CLINIC
- Practice address
- 2811 E Main
Puyallup, WA 98372-3167 - Phone
- (253) 770-7707
- Fax
- (253) 770-8784
- NPI assigned
- Dec 31, 2013
- Organization subpart
- No
Authorized official
- Name
- Mr. Peter Nabegh Ghattas, D.P.D.
- Title
- Denturist
- Phone
- (253) 770-7707
Practitioners 1
-
Peter Nabegh N Ghattas, D.P.D
National Provider Directory
Locations
2811 E Main
Puyallup, WA 98372
Phone (253) 770-7707
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist |
122400000X | DN00000199 | WA | Yes |
Addresses
Primary practice location
2811 E Main
Puyallup, WA 98372-3167
Mailing address
2811 E Main
Puyallup, WA 98372-3167
Phone (253) 770-7707
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5027412 | Medicaid | WA |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.