PT. Defiance Dental Clinic and Lab

Primary specialty

DenturistTaxonomy code 122400000X

License

DN60141899 Issued in WA

Legal business name

PT. DEFIANCE DENTAL CLINIC AND LAB

Practice address

5904 N 45TH St
Tacoma, WA 98407-1902

Phone

(253) 238-1783

NPI assigned

Jan 16, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sofya V KochubeyNPI 1558663500

Title

Owner

Phone

(253) 238-1783

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sofya V Kochubey, DENURIST

  • Denturist
  • Tacoma, WA
  • NPI 1558663500
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389830400000",
    "number": "1467874917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5904 N 45TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984071902",
            "telephone_number": "253-238-1783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5904 N 45TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984071902",
            "telephone_number": "253-238-1783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PT. DEFIANCE DENTAL CLINIC AND LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-16",
        "last_updated": "2014-01-16",
        "status": "A",
        "authorized_official_last_name": "KOCHUBEY",
        "authorized_official_first_name": "SOFYA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-238-1783"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "WA8905",
            "primary": false
        },
        {
            "code": "122400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Denturist",
            "state": "WA",
            "license": "DN60141899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodney Alex Pryor, LICSW, SUDP
• Jayde Sarah Pryzgoda, PH.D.
• Psychaccess, LLC
• Psychological Consulting Services LLC
• Psychotoons
• Leonard Robert Puett III, PA-C
• Terri Marie Puett, RDH
• Jaime G Pugeda, MD
• Puget Sound Allergy Asthma & Immunology
• Puget Sound Center for Integrated Health LLC

• Denturist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Denturist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.