| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 111 1st Ave, Zillah, Washington |
| Authorized Official Name and Position | Andrea Stafford (ADMINISTRATOR) |
| Authorized Official Contact | 5098296611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 537 Zillah WA 98953-0537 Ph: (509) 829-6611 | 111 1st Ave Zillah WA 98953-9779 Ph: (509) 829-6611 |
| NPI Number | 1639625072 |
|---|---|
| Provider Enumeration Date | 08/26/2016 |
| Last Update Date | 08/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639625072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Dr Brent Martin Dmd Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 812 Zillah West Rd, Zillah, WA 98953 Phone: 509-314-6600 Fax: 844-314-6603 | |