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General NPI Number Information
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NPI Number | 1053654525
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Entity Type | Organization
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Legal Business Name | ANDREA M. VANCLEAVE, DDS, PLLC
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 04/02/2013
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Provider Practice Location Address
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Address Line | 2612 YELM HWY SE SUITE A
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City | OLYMPIA
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State | WA
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Zip | 98501-4826
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Country | US
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Telephone | 360-352-3515
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Fax | 360-352-0158
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Provider Business Mailing Address
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Address Line | 2612 YELM HWY SE SUITE A
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City | OLYMPIA
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State | WA
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Zip | 98501-4826
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Country | US
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Telephone | 360-352-3515
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Fax | 360-352-0158
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ANDREA MARIE VANCLEAVE
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Credential | D.D.S.
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Telephone | 360-352-3515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE60284724
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License Number State | WA
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