| Family Dental Center | |
|
1120 W Rose St Walla Walla WA 99362-1662 | |
| (509) 525-0247 | |
| Not Available |
| Full Name | Family Dental Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1120 W Rose St, Walla Walla, Washington |
| Authorized Official Name and Position | Chrisitine Bracewell Trotter (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5098656175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dental Center Po Box 190 Toppenish WA 98948-0190 Ph: (509) 525-0247 | Family Dental Center 1120 W Rose St Walla Walla WA 99362-1662 Ph: (509) 525-0247 |
| NPI Number | 1023147220 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 11/01/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023147220 | NPI | - | NPPES |
| 5010897 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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