| Childrens Village Dental | |
|
3801 Kern Way Yakima WA 98902-6340 | |
| (509) 574-3200 | |
| Not Available |
| Full Name | Childrens Village Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 3801 Kern Way, Yakima, Washington |
| Authorized Official Name and Position | Juan Carlos Olivares (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5098656175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Childrens Village Dental Po Box 190 Toppenish WA 98948-0190 Ph: (509) 574-3200 | Childrens Village Dental 3801 Kern Way Yakima WA 98902-6340 Ph: (509) 574-3200 |
| NPI Number | 1932238136 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 02/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932238136 | NPI | - | NPPES |
| 5027214 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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