| Eleven Eleven Dental | |
|
1111 Columbia St Port Angeles WA 98362-4207 | |
| (360) 457-3183 | |
| Not Available |
| Full Name | Eleven Eleven Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1111 Columbia St, Port Angeles, Washington |
| Authorized Official Name and Position | Gregory L Birch (PRESIDENT/OWNER) |
| Authorized Official Contact | 3604573183 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eleven Eleven Dental 1111 Columbia St Port Angeles WA 98362-4207 Ph: (360) 457-3183 | Eleven Eleven Dental 1111 Columbia St Port Angeles WA 98362-4207 Ph: (360) 457-3183 |
| NPI Number | 1073763041 |
|---|---|
| Provider Enumeration Date | 09/25/2008 |
| Last Update Date | 09/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073763041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 602789281 (Washington) | Primary |
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