MEDICARE: MOUNTAIN VIEW DENTAL CENTER, PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DE00007009	WA

General Provider Information

NPI Number	:	1093950222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VIEW DENTAL CENTER, PS

Provider Business Mailing Address
First Line	:	708 E MOUNTAIN VIEW AVE
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-3862
Country	:	US
Telephone Number	:	509-962-2755
Fax Number	:	509-962-2750

Provider Business Practice Location Address
First Line	:	708 E MOUNTAIN VIEW AVE
Second Line	:
City	:	ELLENSBURG
State	:	WA
Zip	:	98926-3862
Country	:	US
Telephone Number	:	509-962-2755
Fax Number	:	509-962-2750

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. JOHN ANDREW SAVAGE
Credential	:	DMD
Telephone Number	:	509-962-2755

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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