Healthcare Provider Details

I. General information

NPI: 1588611321
Provider Name (Legal Business Name): GENTECH DENTIST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 NE 20TH AVE SUITE 2204
VANCOUVER WA
98686-6410
US

IV. Provider business mailing address

14201 NE 20TH AVE SUITE 2204
VANCOUVER WA
98686-6410
US

V. Phone/Fax

Practice location:
  • Phone: 360-571-8181
  • Fax: 360-573-4029
Mailing address:
  • Phone: 360-571-8181
  • Fax: 360-573-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN BOIE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 360-571-8181