Organization Name: | ELEVEN ELEVEN DENTAL |
NPI Number: | 1073763041 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREGORY L BIRCH (PRESIDENT/OWNER) |
Mailing Address: | 1111 Columbia St Port Angeles |
State: | WA US |
Postal Code: | 983624207 |
Phone Number: | 3604573183 |
Fax Number: | |
NPI Enumeration Date: | 09/25/2008 |
NPI Last Update Date: | 09/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 602789281 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |