| Organization Name: | KAMILCHE DENTAL CENTER |
| NPI Number: | 1043379480 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN R PETERS (OWNER) |
| Mailing Address: | 3100 Se Old Olympic Hwy Shelton |
| State: | WA US |
| Postal Code: | 985847731 |
| Phone Number: | 3604271784 |
| Fax Number: | 3604271818 |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 08/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DN0000036 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |