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740 Ocean Beach Hwy Ste F Longview WA 98632-4061 | |
(360) 414-1400 | |
(360) 414-5223 |
Full Name | |
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Speciality | Dentist |
Location | 740 Ocean Beach Hwy Ste F, Longview, Washington |
Authorized Official Name and Position | Kala Madugula (OWNER) |
Authorized Official Contact | 3154546000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 3189 Syracuse NY 13220-3189 Ph: (315) 454-6000 | 740 Ocean Beach Hwy Ste F Longview WA 98632-4061 Ph: (360) 414-1400 |
NPI Number | 1285978189 |
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Provider Enumeration Date | 11/15/2012 |
Last Update Date | 11/15/2012 |
Identifier | Type | State | Issuer |
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1285978189 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 272750 (Washington) | Primary |
Matthew E Lesh Dmd Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 950 14th Ave, Longview, WA 98632 Phone: 360-200-4924 | |
Dr Azizi Pllc Dental Clinic Medicare: Medicare Enrolled Practice Location: 1538 11th Ave, Longview, WA 98632 Phone: 323-804-1324 |