| Clark County Dental & Denture Clinic | |
|
2701 Ne 114th Ave # K-6 Vancouver WA 98684-4289 | |
| (360) 892-7107 | |
| (360) 891-8361 |
| Full Name | Clark County Dental & Denture Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2701 Ne 114th Ave, Vancouver, Washington |
| Authorized Official Name and Position | Sally Irene Fettig (BUSINESS MANAGER) |
| Authorized Official Contact | 3608927107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark County Dental & Denture Clinic 2701 Ne 114th Ave # K-6 Vancouver WA 98684-4289 Ph: (360) 892-7107 | Clark County Dental & Denture Clinic 2701 Ne 114th Ave # K-6 Vancouver WA 98684-4289 Ph: (360) 892-7107 |
| NPI Number | 1962423129 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962423129 | NPI | - | NPPES |
| 5036074 | Medicaid | WA | |
| 5041082 | Medicaid | WA | |
| 5026356 | Medicaid | WA | |
| 5048616 | Medicaid | WA | |
| 5047576 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DE00008735 (Washington) | Primary |
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