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General NPI Number Information
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NPI Number | 1245378389
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Entity Type | Organization
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Legal Business Name | WHITE SWAN DENTAL CLNIC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 62 BIRD SONG LANE
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City | WHITE SWAN
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State | WA
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Zip | 98952
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Country | US
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Telephone | 509-874-2028
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 693
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City | WHITE SWAN
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State | WA
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Zip | 87841
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Country | US
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Telephone | 509-865-2102
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Fax | 509-865-4986
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Authorized Official
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Title or Position | CEO
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Name | MS. JAY SAMPSON
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Credential |
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Telephone | 509-865-2102
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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 |
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License Number State |
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