Healthcare Provider Details

I. General information

NPI: 1427764562
Provider Name (Legal Business Name): EPP WASHINGTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE 120TH AVE STE 600
VANCOUVER WA
98683-4020
US

IV. Provider business mailing address

PO BOX 1584
BRENTWOOD TN
37024-1584
US

V. Phone/Fax

Practice location:
  • Phone: 360-699-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: JASON BERTOLLINI
Title or Position: INSURANCE MANAGER
Credential:
Phone: 315-450-0763