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General NPI Number Information
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NPI Number | 1811495211
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Entity Type | Organization
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Legal Business Name | ANDERSON & BRAULT, PLLC
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 409 W MAIN ST
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City | KELSO
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State | WA
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Zip | 98626-1117
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Country | US
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Telephone | 360-577-1153
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Fax | 360-425-1540
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Provider Business Mailing Address
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Address Line | 409 W MAIN ST
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City | KELSO
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State | WA
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Zip | 98626-1117
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Country | US
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Telephone | 360-577-1153
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Fax | 360-425-1540
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LE ANN BAXTER WINIGER
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Credential |
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Telephone | 360-577-1153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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