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1717 Olympia Way Suite 108 Longview WA 98632-3929 | |
(360) 636-1900 | |
(360) 636-7317 |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 1717 Olympia Way, Longview, Washington |
Authorized Official Name and Position | Hazar Jaber (CEO) |
Authorized Official Contact | 3606361900 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1717 Olympia Way Suite 108 Longview WA 98632-3929 Ph: (360) 636-1900 | 1717 Olympia Way Suite 108 Longview WA 98632-3929 Ph: (360) 636-1900 |
NPI Number | 1770806275 |
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Provider Enumeration Date | 03/11/2010 |
Last Update Date | 02/10/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1770806275 | NPI | - | NPPES |
5045679 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Matthew E Lesh Dmd Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 950 14th Ave, Longview, WA 98632 Phone: 360-200-4924 | |
Dr Azizi Pllc Dental Clinic Medicare: Medicare Enrolled Practice Location: 1538 11th Ave, Longview, WA 98632 Phone: 323-804-1324 |