Bonney Lake Dental LLC

NPI #1073088423 in Bonney Lake, Washington

Provider Information

NPI Number: 1073088423
Entity Type: Organization
Organization Name: Bonney Lake Dental LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Oct 11, 2018
Last Updated: Oct 11, 2018

Practice Location

Address: 19410 STATE ROUTE 410 E
City: Bonney Lake
State: Washington
ZIP Code: 98391-8470
Phone: (253) 780-7003

Authorized Official

Name: TRAVIS PROBST, DDS
Title: OWNER /DENTIST
Phone: (719) 352-5773

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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