1003210014 NPI number — STEVEN S. BROUGHTON, D.D.S. & ANGELA L. DUNN, D.D.S., P.L.L.C.

Table of content: (NPI 1003210014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003210014 NPI number — STEVEN S. BROUGHTON, D.D.S. & ANGELA L. DUNN, D.D.S., P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN S. BROUGHTON, D.D.S. & ANGELA L. DUNN, D.D.S., P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003210014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8012 112TH STREET CT E
Provider Second Line Business Mailing Address:
SUITE #320
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98373-7856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-848-2331
Provider Business Mailing Address Fax Number:
253-840-4033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8012 112TH STREET CT E
Provider Second Line Business Practice Location Address:
SUITE #320
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98373-7856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-848-2331
Provider Business Practice Location Address Fax Number:
253-840-4033
Provider Enumeration Date:
10/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST & PARTNER
Authorized Official Telephone Number:
253-848-2331

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE60098994 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE7977 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: DE60096180 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60171760 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60223497 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60301791 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60365691 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60237858 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60387807 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE8497 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60244633 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60485870 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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