Healthcare Provider Details

I. General information

NPI: 1952420309
Provider Name (Legal Business Name): CARING DENTAL NORTHWEST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12503 SE MILL PLAIN BLVD SUITE 215
VANCOUVER WA
98684-4009
US

IV. Provider business mailing address

12503 SE MILL PLAIN BLVD SUITE 215
VANCOUVER WA
98684-4009
US

V. Phone/Fax

Practice location:
  • Phone: 360-891-9111
  • Fax: 360-891-9119
Mailing address:
  • Phone: 360-891-9111
  • Fax: 360-891-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9452
License Number StateWA

VIII. Authorized Official

Name: DR. RICHARD E. MOUNCE
Title or Position: OWNER
Credential: D.D.S.
Phone: 360-891-9111