Costa Verde 3-D Imaging Center, Pllc

NPI #1477983450 in Olympia, Washington

Provider Information

NPI Number: 1477983450
Entity Type: Organization
Organization Name: Costa Verde 3-D Imaging Center, Pllc
Primary Specialty: Dentist
Enumeration Date: Nov 12, 2013
Last Updated: Nov 12, 2013

Practice Location

Address: 1320 HARRISON AVE NW
City: Olympia
State: Washington
ZIP Code: 98502-5349
Phone: (360) 943-5551

Authorized Official

Name: DR. ANGEL AGUSTIN VEGA, DDS
Title: OWNER
Phone: (360) 943-5551

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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