| Grandview Dental Clinic | |
|
1000 Wallace Way Grandview WA 98930-8805 | |
| (509) 882-4491 | |
| Not Available |
| Full Name | Grandview Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1000 Wallace Way, Grandview, Washington |
| Authorized Official Name and Position | Shannon Fernandez (BILLING VP) |
| Authorized Official Contact | 5098656175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grandview Dental Clinic Po Box 190 Toppenish WA 98948-0190 Ph: (509) 882-4491 | Grandview Dental Clinic 1000 Wallace Way Grandview WA 98930-8805 Ph: (509) 882-4491 |
| NPI Number | 1396874590 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 11/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396874590 | NPI | - | NPPES |
| 5010863 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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