| Odessa Dental Clinic | |
|
20 W 1st Ave Odessa WA 99159 | |
| (209) 982-2605 | |
| Not Available |
| Full Name | Odessa Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 20 W 1st Ave, Odessa, Washington |
| Authorized Official Name and Position | Nina Stewart (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Contact | 5204314313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Odessa Dental Clinic Po Box 429 Odessa WA 99159-0429 Ph: (509) 982-2605 | Odessa Dental Clinic 20 W 1st Ave Odessa WA 99159 Ph: (209) 982-2605 |
| NPI Number | 1831683168 |
|---|---|
| Provider Enumeration Date | 06/20/2018 |
| Last Update Date | 07/03/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831683168 | NPI | - | NPPES |
| 604262185 | Other | WA | STATE OF WASHINGTON UBI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DE00010090 (Washington) | Primary |
| 122300000X | Dentist | DE00008440 (Washington) | Secondary |
Odessa Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 20 W 1st, Odessa, WA 99159 Phone: 509-982-2605 Fax: 509-982-9951 |