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General NPI Number Information
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NPI Number | 1831454990
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Entity Type | Organization
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Legal Business Name | AMY PUGH DMD PS
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 10115 SE MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98664-4522
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Country | US
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Telephone | 360-256-7455
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Fax | 360-892-5533
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Provider Business Mailing Address
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Address Line | 10115 SE MILL PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98664-4522
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Country | US
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Telephone | 360-256-7455
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Fax | 360-892-5533
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMY PUGH
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Credential | D.M.D.
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Telephone | 360-256-7455
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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 | DE00010330
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License Number State | WA
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