Mountain Lake Denture Services, PLLC

Primary specialty

DenturistTaxonomy code 122400000X

Legal business name

MOUNTAIN LAKE DENTURE SERVICES, PLLC

Practice address

1225 Meade Ave
Prosser, WA 99350-1423

Phone

(509) 786-2963

Fax

(888) 656-9322

NPI assigned

Jul 21, 2010

Last updated

Jul 21, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Joshua D Brooks, DPD

Title

Member

Phone

(509) 303-9090

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1279670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279670400000",
    "number": "1962715805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 MEADE AVE",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993501423",
            "telephone_number": "509-786-2963",
            "fax_number": "888-656-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 MEADE AVE",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993501423",
            "telephone_number": "509-786-2963",
            "fax_number": "888-656-9322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN LAKE DENTURE SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-21",
        "last_updated": "2010-07-21",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "509-303-9090",
        "authorized_official_credential": "DPD"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew John Mirelez, LMT
• Anne Louise Mochel
• Reeshma S Mohammed, MSN, FNP-BC
• Pamela M Morris, A.R.N.P.
• Heather S Morse, ARNP
• Terry G Murphy, MD MS FACEP
• Mariana S Neeway, ARNP
• Amanda Lorraine Nesary, L.M.P.
• Coy M Neville, PTA
• Katheryn Norris

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2010; 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.