Healthcare Provider Details

I. General information

NPI: 1720113673
Provider Name (Legal Business Name): WILLIAM J PRITCHARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 MAIN ST
VANCOUVER WA
98663-2228
US

IV. Provider business mailing address

3700 MAIN ST
VANCOUVER WA
98663-2228
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-1578
  • Fax:
Mailing address:
  • Phone: 360-695-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4531
License Number StateWA

VIII. Authorized Official

Name: DR. WILLIAM J PRITCHARD
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 360-695-1578