1427689421 NPI number — TRI-CITIES DENTURE STUDIO PLLC

Table of content: DR. MINA MIKHAIL D.C (NPI 1659713485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427689421 NPI number — TRI-CITIES DENTURE STUDIO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-CITIES DENTURE STUDIO PLLC
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:
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:
1427689421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2984 SEDONA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99354-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-788-5910
Provider Business Mailing Address Fax Number:
509-204-8045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3909 CREEKSIDE LOOP STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-4880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-204-8305
Provider Business Practice Location Address Fax Number:
509-204-8045
Provider Enumeration Date:
01/29/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ALSBURY
Authorized Official First Name:
JASON
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
DENTURIST
Authorized Official Telephone Number:
509-788-5910

Provider Taxonomy Codes

  • Taxonomy code: 122400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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