MEDICARE: WASHINGTON DENTAL CORPORATION, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1033633920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON DENTAL CORPORATION, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8500
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	1214 SW SCOTTON WAY STE 101&103
Second Line	:
City	:	BATTLE GROUND
State	:	WA
Zip	:	98604-2715
Country	:	US
Telephone Number	:	360-843-2001
Fax Number	:	360-214-3399

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. WILLIAM J MCGLASHAN
Credential	:	DDS
Telephone Number	:	360-843-2001

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	08/01/2017

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