Healthcare Provider Details

I. General information

NPI: 1295164333
Provider Name (Legal Business Name): BRIAN C. ALDER, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 NE HAZEL DELL AVE
VANCOUVER WA
98665-8067
US

IV. Provider business mailing address

8700 NE HAZEL DELL AVE
VANCOUVER WA
98665-8067
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-8700
  • Fax: 360-573-8008
Mailing address:
  • Phone: 360-574-8700
  • Fax: 360-573-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CALL ALDER
Title or Position: PRESIDENT
Credential: DDS
Phone: 360-574-8700