is a Dental Clinic in University Place, Washington. It is located at 4103 Bridgeport Way W, Suite A, University Place, WA and its contact number is 253-565-4474. The authorized person for is Gary R Shaw
who is Dentist Owner of the clinic and their contact number is 253-565-4474. The primary license number for is DE00006436 (Dentist) in Washington. Clinic have dental surgeons who are specialized in dentistry, diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.
Complete Clinic Profile:
Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
Name:
Specialization:
Dentistry
Clinic Address:
4103 Bridgeport Way W, Suite A, University Place, Washington, 98466
Phone:
253-565-4474
Fax:
253-565-6848
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
Name:
Gary R Shaw
Position:
Dentist Owner
Contact Number:
253-565-4474
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for clinic are as mentioned below.
NPI Number:
1265535652
NPI Enumeration Date:
07 Sep, 2006
NPI Last Update On:
08 Oct, 2014
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for are as mentioned below.
Specialization
License Number
State
Status
Dentist
DE00006436
Washington
Primary
Dentist
1431549922
Utah
Secondary
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
601484620
Other
Washington
Wastemployment
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
4103 Bridgeport Way W, Suite A University Place, Washington
Zip:
98466
Phone Number:
253-565-4474
Fax Number:
253-565-6848
Patients can reach at 4103 Bridgeport Way W, Suite A, University Place, Washington or can call to book an appointment on 253-565-4474. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 10 February, 2025.