| |
120 E Fir St Ste 101 Mount Vernon WA 98273-2964 | |
(360) 424-5175 | |
(360) 424-5177 |
Full Name | |
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Speciality | Dentist - Periodontics |
Location | 120 E Fir St Ste 101, Mount Vernon, Washington |
Authorized Official Name and Position | Harbinder S Bal (PRESIDENT) |
Authorized Official Contact | 3604245175 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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120 E Fir St Ste 101 Mount Vernon WA 98273-2964 Ph: (360) 424-5175 | 120 E Fir St Ste 101 Mount Vernon WA 98273-2964 Ph: (360) 424-5175 |
NPI Number | 1609116656 |
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Provider Enumeration Date | 02/27/2013 |
Last Update Date | 12/27/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609116656 | NPI | - | NPPES |
DE00010010 | Other | WA | DENTAL LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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