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General NPI Number Information
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NPI Number | 1699128728
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Entity Type | Organization
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Legal Business Name | GREEN DENTAL
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 1008 5TH ST
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City | WENATCHEE
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State | WA
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Zip | 98801-1823
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Country | US
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Telephone | 509-662-8815
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Fax | 509-667-8725
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Provider Business Mailing Address
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Address Line | 1008 5TH ST
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City | WENATCHEE
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State | WA
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Zip | 98801-1823
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Country | US
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Telephone | 509-662-8815
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Fax | 509-667-8725
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TRISH NIERMAN
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Credential |
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Telephone | 509-662-8815
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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 | 60022722
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License Number State | WA
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