Healthcare Provider Details

I. General information

NPI: 1427373869
Provider Name (Legal Business Name): CAZAN & MENKE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W. 13326 14TH STREET
AIRWAY HEIGHTS WA
99001
US

IV. Provider business mailing address

P.O. BOX 1570
AIRWAY HEIGHTS WA
99001-1570
US

V. Phone/Fax

Practice location:
  • Phone: 509-244-3655
  • Fax: 509-244-9527
Mailing address:
  • Phone: 509-244-3655
  • Fax: 509-244-9527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number60051632
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4519
License Number StateWA

VIII. Authorized Official

Name: ALAN O CAZAN
Title or Position: DENTIST/OWNER
Credential: D.D.S.
Phone: 509-244-3655