| Mirror Pond Dental, Llc | |
|
1412 Ne 134th St. Suite 120 Vancouver WA 98685 | |
| (360) 573-4848 | |
| Not Available |
| Full Name | Mirror Pond Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 1412 Ne 134th St. Suite 120, Vancouver, Washington |
| Authorized Official Name and Position | Marc Andrew Nordstrom (MEMBER) |
| Authorized Official Contact | 5416107837 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mirror Pond Dental, Llc 1475 Sw Chandler Ave Ste 201 Bend OR 97702-3240 Ph: (541) 610-7837 | Mirror Pond Dental, Llc 1412 Ne 134th St. Suite 120 Vancouver WA 98685 Ph: (360) 573-4848 |
| NPI Number | 1548719461 |
|---|---|
| Provider Enumeration Date | 10/04/2016 |
| Last Update Date | 10/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548719461 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DE60682826 (Washington) | Primary |
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