Provider Demographics
NPI:1356560593
Name:RENTON DENTURE CLINIC LLC
Entity type:Organization
Organization Name:RENTON DENTURE CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-271-7740
Mailing Address - Street 1:419 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-2541
Mailing Address - Country:US
Mailing Address - Phone:425-271-7740
Mailing Address - Fax:425-271-9828
Practice Address - Street 1:419 S 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2541
Practice Address - Country:US
Practice Address - Phone:425-271-7740
Practice Address - Fax:425-271-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6348261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental