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General NPI Number Information
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NPI Number | 1245770353
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Entity Type | Organization
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Legal Business Name | POMEROY DENTAL CENTER
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 813 1/2 COLUMBIA ST
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City | POMEROY
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State | WA
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Zip | 99347
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Country | US
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Telephone | 509-843-3495
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Fax | 509-843-3496
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Provider Business Mailing Address
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Address Line | 813 1/2 COLUMBIA ST
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City | POMEROY
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State | WA
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Zip | 99347
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Country | US
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Telephone | 509-843-3495
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Fax | 509-843-3496
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAN R. WILSON
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Credential |
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Telephone | 509-843-3495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5974
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License Number State | WA
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