Healthcare Provider Details

I. General information

NPI: 1700919990
Provider Name (Legal Business Name): KATRINA GAIL EMBREE DENTAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17401 SE 28TH ST
VANCOUVER WA
98684-3427
US

IV. Provider business mailing address

17401 SE 28TH ST
VANCOUVER WA
98683-3427
US

V. Phone/Fax

Practice location:
  • Phone: 360-448-1680
  • Fax:
Mailing address:
  • Phone: 360-448-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: