| Othello Dental Center | |
|
1515 E Columbia St Othello WA 99344-1846 | |
| (509) 488-5256 | |
| (509) 488-9939 |
| Full Name | Othello Dental Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1515 E Columbia St, Othello, Washington |
| Authorized Official Name and Position | Joshua Bunch (CFO) |
| Authorized Official Contact | 5094885250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Othello Dental Center 1515 E Columbia St Othello WA 99344-1846 Ph: (509) 488-5256 | Othello Dental Center 1515 E Columbia St Othello WA 99344-1846 Ph: (509) 488-5256 |
| NPI Number | 1891913042 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 09/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891913042 | NPI | - | NPPES |
| 0134585 | Other | WA | DEPT L&I # |
| 1021671 | Medicaid | WA | |
| 8923240 | Other | WA | CRIME VICTIMS # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Washington) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Washington) | Primary |
Columbia Basin Health Association Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 475 N 14th Ave, Othello, WA 99344 Phone: 509-488-5256 Fax: 509-488-9939 | |
Othello Dental Arts Clinic, P.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1355 E Hemlock St, Othello, WA 99344 Phone: 509-488-5216 Fax: 509-488-9496 |