| Cascade Dental Center | |
|
1211 S Gold St Centralia WA 98531-3715 | |
| (360) 736-5040 | |
| (360) 736-1979 |
| Full Name | Cascade Dental Center |
|---|---|
| Speciality | Dentist |
| Location | 1211 S Gold St, Centralia, Washington |
| Authorized Official Name and Position | Mikhai Cong Ta (OWNER) |
| Authorized Official Contact | 9099361803 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cascade Dental Center Po Box 676 Centralia WA 98531-0676 Ph: (360) 736-5040 | Cascade Dental Center 1211 S Gold St Centralia WA 98531-3715 Ph: (360) 736-5040 |
| NPI Number | 1003117946 |
|---|---|
| Provider Enumeration Date | 11/09/2010 |
| Last Update Date | 06/24/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003117946 | NPI | - | NPPES |
| 2000984 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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