Healthcare Provider Details

I. General information

NPI: 1942119631
Provider Name (Legal Business Name): GOOD FIT DENTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 SE CHKALOV DR STE 47
VANCOUVER WA
98683-5278
US

IV. Provider business mailing address

14820 NE 74TH CIR
VANCOUVER WA
98682-5097
US

V. Phone/Fax

Practice location:
  • Phone: 360-216-6258
  • Fax:
Mailing address:
  • Phone: 360-216-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: MIN-U TAN
Title or Position: DENTURIST360
Credential: LD
Phone: 360-281-5388