Alpha Denture Clinic, Inc

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

DN000021 Issued in WA

Legal business name

ALPHA DENTURE CLINIC, INC

Practice address

1242 State Ave
Suite G
Marysville, WA 98270-3672

Phone

(360) 658-0256

Fax

(360) 658-7280

NPI assigned

Feb 8, 2012

Last updated

Feb 8, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

ALPHA DENTURE CLINIC, INCAs reported in NPPES

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

Authorized official

Name

Mrs. Dorothy Jensen

Title

Business MGR

Phone

(360) 658-0256

Specialties & licenses 1

Addresses

Part of

Alpha Denture Clinic Inc

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

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328659200000",
    "number": "1730451527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1242 STATE AVE",
            "address_2": "SUITE G",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982703672",
            "telephone_number": "360-658-0256",
            "fax_number": "360-658-7280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1242 STATE AVE",
            "address_2": "SUITE G",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982703672",
            "telephone_number": "360-658-0256",
            "fax_number": "360-658-7280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA DENTURE CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALPHA DENTURE CLINIC, INC",
        "enumeration_date": "2012-02-08",
        "last_updated": "2012-02-08",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_title_or_position": "BUSINESS MGR",
        "authorized_official_telephone_number": "360-658-0256",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "WA",
            "license": "DN000021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Marysville, WA
• Providers in Marysville, WA by specialty
• Exclusive Provider Organization in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2012; 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.