NPIMap

Organization Active NPI

The Professional Denture Center

  • Dentist
  • Moses Lake, WA
National Provider Identifier
1962916379
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
60292621 Issued in WA
Legal business name
THE PROFESSIONAL DENTURE CENTER
Practice address
835 E Colonial Ave Ste 103
Moses Lake, WA 98837-4617
Phone
(509) 707-0707
NPI assigned
Nov 21, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Authorized official

Name
Dr. Jonathan Munger Dickson, DMDNPI 1629398425
Title
Doctor/Owner
Phone
(253) 230-8084

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 60292621 WA Primary
DenturistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122400000X 60772847 WA

Addresses

Primary practice location

835 E Colonial Ave Ste 103
Moses Lake, WA 98837-4617

Mailing address

835 E Colonial Ave Ste 103
Moses Lake, WA 98837-4617
Phone (509) 707-0707

Other practice location 1

533 South Mission St
Wenatchee, WA 98801
Phone (509) 664-7308

Other identifiers 1

IdentifierTypeStateIssuer
2059589MedicaidWA

Other names 1

  • Professional Denture Clinic Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Professional Denture Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1511222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1962916379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 E COLONIAL AVE STE 103",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988374617",
            "telephone_number": "509-707-0707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 E COLONIAL AVE STE 103",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988374617",
            "telephone_number": "509-707-0707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "533 South Mission St",
            "address_purpose": "LOCATION",
            "city": "Wenatchee",
            "state": "WA",
            "postal_code": "98801",
            "country_code": "US",
            "telephone_number": "509-664-7308",
            "fax_number": "509-664-4068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE PROFESSIONAL DENTURE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-21",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "DICKSON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "MUNGER",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "253-230-8084",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "60292621",
            "primary": true
        },
        {
            "code": "122400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Denturist",
            "state": "WA",
            "license": "60772847",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2059589",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Denture Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Moses Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; 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.