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120 E Fir St Ste 101 Mount Vernon WA 98273-2964 | |
| (360) 424-5175 | |
| (360) 424-5177 |
| Full Name | |
|---|---|
| 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 |
|---|---|
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 |
|---|---|
| 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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