| Pullman Smiles | |
|
1410 Se Bishop Blvd # 1s Pullman WA 99163-5419 | |
| (509) 334-6700 | |
| (509) 334-9239 |
| Full Name | Pullman Smiles |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1410 Se Bishop Blvd # 1s, Pullman, Washington |
| Authorized Official Name and Position | Jonathan Marvin Fairbanks (DENTIST) |
| Authorized Official Contact | 5093327463 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pullman Smiles 1410 Se Bishop Blvd # 1s Pullman WA 99163-5419 Ph: (509) 334-6700 | Pullman Smiles 1410 Se Bishop Blvd # 1s Pullman WA 99163-5419 Ph: (509) 334-6700 |
| NPI Number | 1144546102 |
|---|---|
| Provider Enumeration Date | 04/15/2010 |
| Last Update Date | 03/16/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144546102 | NPI | - | NPPES |
| 5033295 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE00008587 (Washington) | Primary |
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