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WILLIAM J. BUSACCA, D.D.S., P.S.

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Company Details

Legal Name: WILLIAM J. BUSACCA, D.D.S., P.S.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: November 8th 1979
Date of Dissolution: March 1st 2016
Expiration date: 30 Nov 2015
UBI Number: 600 345 585

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Registered Agent Information

Name Role Address
WILLIAM J BUSACCA Registered Agent 612 W BIRCH ST, SHELTON, WA, 98584-1739, UNITED STATES

Key Officers & Management

Name Role Address
LYNN BUSACDA Governing Person 612 W BIRCH STREET, SHELTON, WA, 98584, UNITED STATES
WILLIAM BUSACCA Governing Person 612 W BIRCH STREET, SHELTON, WA, 98584, UNITED STATES

National Provider Identifier

NPI Number:
1043592397

Authorized Person:

Name:
MRS. LEAH R HENDRICKSON
Role:
OFFICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
1223G0001X - General Practice Dentistry
Is Primary:
Yes

Contacts:

Fax:
3604266361
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