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222 Lilly Rd Ne Olympia WA 98506-6103 | |
| (360) 459-5885 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 222 Lilly Rd Ne, Olympia, Washington |
| Authorized Official Name and Position | Deborah J Gowan (OFFICE BUSINESS MANAGER) |
| Authorized Official Contact | 3604595885 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
222 Lilly Rd Ne Olympia WA 98506-5031 Ph: (360) 459-5885 | 222 Lilly Rd Ne Olympia WA 98506-6103 Ph: (360) 459-5885 |
| NPI Number | 1598979866 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 01/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598979866 | NPI | - | NPPES |
| 122300000X | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (Washington) | Primary |
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