Healthcare Provider Details

I. General information

NPI: 1639673510
Provider Name (Legal Business Name): JOHNSON AND MCDONALD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N CHELAN AVE
WENATCHEE WA
98801-2107
US

IV. Provider business mailing address

304 N CHELAN AVE
WENATCHEE WA
98801-2107
US

V. Phone/Fax

Practice location:
  • Phone: 509-663-0068
  • Fax: 509-663-0060
Mailing address:
  • Phone: 509-663-0068
  • Fax: 509-663-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60337452
License Number StateWA

VIII. Authorized Official

Name: MS. ELIZABETH KAYE PATTERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-663-0068