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Ms. Maenell Sullivan, DENTURISTDPD
Denturist in Tenino, Washington
NPI 1679675367

Maenell Sullivan is a Denturist based in Tenino, WA. Maenell Sullivan practices in Tenino, WA and has the professional credentials of DENTURISTDPD. The NPI Number for Maenell Sullivan is 1679675367 and holds a License No. DN361 (Washington).

The current practice location address for Maenell Sullivan is 296 Sussex Ave W, Tenino, WA and can be reached out via phone at 360-264-5500 and via fax at 360-264-5500.

Location: 296 Sussex Ave W, Tenino, WA, 98589
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679675367
Provider Name
Maenell Sullivan
Credential
DENTURISTDPD
Provider Entity Type
Individual
Gender
Female
Address
296 Sussex Ave W, Tenino, WA, 98589
Phone Number
360-264-5500
Fax Number
360-264-5500
Provider Enumeration Date
09/02/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
5045273 01 WA DSHS
institution
Provider Business Practice Location Address Details
Address
296 Sussex Ave W
City
Tenino
State
Washington
Zip
98589
Phone Number
360-264-5500
Fax Number
360-264-5500
person
Provider Business Mailing Address Details
Address
296 Sussex Ave W
City
Tenino
State
Washington
Zip
98589
Phone Number
360-264-5500
Fax Number
360-264-5500
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Denturist
Speciality
-
Taxonomy
122400000X
License No.
DN361 (Washington)
Definition
Definition to come.
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