| |
1401 Nw 1st St Battle Ground WA 98604-4540 | |
(360) 666-5700 | |
(360) 666-5701 |
Full Name | |
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Speciality | Dentist - Prosthodontics |
Location | 1401 Nw 1st St, Battle Ground, Washington |
Authorized Official Name and Position | Ellis Burke Jardine (OWNER) |
Authorized Official Contact | 4808623185 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1401 Nw 1st St Battle Ground WA 98604-4540 Ph: (360) 666-5700 | 1401 Nw 1st St Battle Ground WA 98604-4540 Ph: (360) 666-5700 |
NPI Number | 1821456419 |
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Provider Enumeration Date | 02/10/2016 |
Last Update Date | 03/07/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821456419 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (Washington) | Secondary |
1223P0700X | Dentist - Prosthodontics | (Washington) | Primary |
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