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General NPI Number Information
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NPI Number | 1104329994
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Entity Type | Organization
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Legal Business Name | THE DENTIST@FELIDA
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Dates
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Enumeration Date | 03/17/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 10710 NW LAKESHORE AVE
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City | VANCOUVER
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State | WA
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Zip | 98685-4786
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Country | US
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Telephone | 206-613-9193
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Fax |
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Provider Business Mailing Address
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Address Line | 2012 S 19TH WAY
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City | RIDGEFIELD
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State | WA
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Zip | 98642-9279
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. CHRISTIAN M OKAFOR
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Credential | DDS, PHD.
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Telephone | 206-613-9193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE60567260
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License Number State | WA
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