Healthcare Provider Details

I. General information

NPI: 1649581653
Provider Name (Legal Business Name): JOSEPH FLAHERTY CHURCHILL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOWER ELWHA DENTAL CLINIC 243511 US 101
PORT ANGELES WA
98363
US

IV. Provider business mailing address

LOWER ELWHA DENTAL CLINIC 243511 US 101
PORT ANGELES WA
98363
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-6252
  • Fax: 360-797-1369
Mailing address:
  • Phone: 360-452-6252
  • Fax: 360-797-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60821138
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: