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504 Union Ave Se Olympia WA 98501-1429 | |
| (360) 943-6331 | |
| (360) 943-2293 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 504 Union Ave Se, Olympia, Washington |
| Authorized Official Name and Position | Colby J Cockrell (OWNER) |
| Authorized Official Contact | 3609436331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2525 Olympia WA 98507-2525 Ph: (360) 943-6331 | 504 Union Ave Se Olympia WA 98501-1429 Ph: (360) 943-6331 |
| NPI Number | 1982918983 |
|---|---|
| Provider Enumeration Date | 08/02/2010 |
| Last Update Date | 08/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982918983 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DE60023798 (Washington) | Primary |
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