| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 20 W 1st, Odessa, Washington |
| Authorized Official Name and Position | Michael P Condon (OWNER) |
| Authorized Official Contact | 5099822605 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 429 20 W First Odessa WA 99159-0429 Ph: (509) 982-2605 | 20 W 1st Odessa WA 99159-0459 Ph: (509) 982-2605 |
| NPI Number | 1871548925 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 11/02/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871548925 | NPI | - | NPPES |
| 5054358 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 8440 (Washington) | Primary |