Puyallup Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DE 60198294 Issued in WA

Legal business name

PUYALLUP DENTAL, LLC

Practice address

16420 Meridian E
Puyallup, WA 98375-2514

Phone

(253) 475-9120

Fax

(253) 475-9284

NPI assigned

Nov 1, 2012

Last updated

Nov 1, 2012By 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

Dr. Travis John Probst, D.D.S.

Title

Dentist

Phone

(253) 475-9120

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1351728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351728000000",
    "number": "1992059737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16420 MERIDIAN E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983752514",
            "telephone_number": "253-475-9120",
            "fax_number": "253-475-9284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16420 MERIDIAN E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983752514",
            "telephone_number": "253-475-9120",
            "fax_number": "253-475-9284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-01",
        "last_updated": "2012-11-01",
        "status": "A",
        "authorized_official_last_name": "PROBST",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "253-475-9120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE 60198294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Puyallup Imaging Consultants LLC
• Puyallup Loving Arms Afh LLC
• Puyallup Open Imaging LLC

• Dentist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.