| Olympic Dental Center Llc | |
|
716 W Main St Centralia WA 98531-2847 | |
| (360) 736-0795 | |
| (360) 330-1637 |
| Full Name | Olympic Dental Center Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 716 W Main St, Centralia, Washington |
| Authorized Official Name and Position | John M Anderson (OWNER) |
| Authorized Official Contact | 3607360795 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Olympic Dental Center Llc 716 W Main St Centralia WA 98531-2847 Ph: (360) 736-0795 | Olympic Dental Center Llc 716 W Main St Centralia WA 98531-2847 Ph: (360) 736-0795 |
| NPI Number | 1841318912 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841318912 | NPI | - | NPPES |
| 5038377 | Medicaid | WA | |
| 1412978 | Other | WA | UNITED CONCORDIA PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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