Healthcare Provider Details

I. General information

NPI: 1598958324
Provider Name (Legal Business Name): DRUE PICKENS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SE 164TH AVE STE 103
VANCOUVER WA
98684-9297
US

IV. Provider business mailing address

605 SE 164TH AVE STE 103
VANCOUVER WA
98684-9297
US

V. Phone/Fax

Practice location:
  • Phone: 360-254-6411
  • Fax:
Mailing address:
  • Phone: 360-254-6411
  • Fax: 360-944-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60502335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: