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General NPI Number Information
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NPI Number | 1437389160
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Entity Type | Organization
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Legal Business Name | W. CURTIS MATHISEN D.D.S.
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 640 N. MAIN ST.
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City | WHITE SALMON
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State | WA
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Zip | 98672
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Country | US
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Telephone | 509-493-2244
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Fax | 509-493-2242
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Provider Business Mailing Address
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Address Line | P.O. BOX 447
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City | WHITE SALMON
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State | WA
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Zip | 98672
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Country | US
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Telephone | 509-493-2244
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Fax | 509-493-2242
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM CURTIS MATHISEN
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Credential | D.D.S.
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Telephone | 509-493-2244
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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 | DE 00004769
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License Number State | WA
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