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General NPI Number Information
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NPI Number | 1811121528
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Entity Type | Organization
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Legal Business Name | VANCOUVER ORTHODONTIC SPECIALISTS PLLC
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 406 SE 131ST AVE STE 306
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City | VANCOUVER
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State | WA
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Zip | 98683-4014
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Country | US
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Telephone | 360-883-6713
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Fax | 360-882-0386
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Provider Business Mailing Address
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Address Line | 406 SE 131ST AVE STE 306
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City | VANCOUVER
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State | WA
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Zip | 98683-4014
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Country | US
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Telephone | 360-883-6713
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Fax | 360-882-0386
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Authorized Official
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Title or Position | ORTHODONTIST/ OWNER
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Name | DR. DURK V IRWIN
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Credential | D.M.D.
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Telephone | 360-883-6713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8025
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License Number State | WA
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