MEDICARE: FRANK F VEDELAGO DDS PS

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	1223G0001X	General Practice Dentistry	2897	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	173417	OTHER	WA	UNITED CONCORDIA
2	02679	OTHER	WA	WASH DENTAL SERVICE

General Provider Information

NPI Number	:	1053409037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK F VEDELAGO DDS PS

Provider Business Mailing Address
First Line	:	N 4610 N ASH #101
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-1482
Country	:	US
Telephone Number	:	509-326-8646
Fax Number	:	509-325-5334

Provider Business Practice Location Address
First Line	:	N 4610 N ASH #101
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-1482
Country	:	US
Telephone Number	:	509-326-8646
Fax Number	:	509-325-5334

Authorized Official
Title or Position	:	PRES
Name	:	DR. FRANK FELIX VEDELAGO
Credential	:	DDS
Telephone Number	:	509-326-8646

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/16/2008

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