Healthcare Provider Details

I. General information

NPI: 1407564685
Provider Name (Legal Business Name): EXPERT ENDODONTICS NORTHWEST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12500 SE 2ND CIR STE 135
VANCOUVER WA
98684-6031
US

IV. Provider business mailing address

12500 SE 2ND CIR STE 135
VANCOUVER WA
98684-6031
US

V. Phone/Fax

Practice location:
  • Phone: 360-695-0994
  • Fax: 360-695-8994
Mailing address:
  • Phone: 360-695-0994
  • Fax: 360-695-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER JAMES
Title or Position: MEMBER
Credential: DMD
Phone: 360-836-2962