Basic Information
| Provider Information | |||||||||
| NPI: | 1861735565 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VANCOUVER DENTAL CARE, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1418 NE 78TH ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986659631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604500075 | ||||||||
| FaxNumber: | 3607192314 | ||||||||
| Practice Location | |||||||||
| Address1: | 1418 NE 78TH ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986659631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604500075 | ||||||||
| FaxNumber: | 3607192314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2013 | ||||||||
| LastUpdateDate: | 04/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | FAHMY | ||||||||
| AuthorizedOfficialFirstName: | TAREK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 4405061913 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DE60085479 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.