Provider Demographics
NPI:1871035873
Name:DENTURE DESIGN STUDIO
Entity type:Organization
Organization Name:DENTURE DESIGN STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-529-1469
Mailing Address - Street 1:1298 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-9727
Mailing Address - Country:US
Mailing Address - Phone:509-529-1469
Mailing Address - Fax:509-525-0387
Practice Address - Street 1:1298 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-9727
Practice Address - Country:US
Practice Address - Phone:509-529-1469
Practice Address - Fax:509-525-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000447261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental