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General NPI Number Information
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NPI Number | 1013109115
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Entity Type | Organization
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Legal Business Name | CANEPA DENTAL, LLC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1405 SE 164TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-9644
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Country | US
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Telephone | 360-514-0707
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Fax | 360-514-9395
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Provider Business Mailing Address
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Address Line | 1405 SE 164TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-9644
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Country | US
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Telephone | 360-514-0707
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Fax | 360-514-9395
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ALBERT B CANEPA III
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Credential | DDS
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Telephone | 360-514-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00007372
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License Number State | WA
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