Healthcare Provider Details

I. General information

NPI: 1538434139
Provider Name (Legal Business Name): VANCOUVER ENDODONTIC SPECIALISTS PC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SE 117TH AVE SUITE 110
VANCOUVER WA
98683-5297
US

IV. Provider business mailing address

601 SE 117TH AVE SUITE 110
VANCOUVER WA
98683-5297
US

V. Phone/Fax

Practice location:
  • Phone: 360-334-4400
  • Fax: 360-883-0468
Mailing address:
  • Phone: 360-334-4400
  • Fax: 360-883-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8567
License Number StateWA

VIII. Authorized Official

Name: DR. JOHN KEVIN SCHOW
Title or Position: PRESIDENT
Credential: D.M.D
Phone: 360-334-4400