Provider Demographics
NPI:1013393974
Name:ORAL HEALTH & PREVENTIVE SERVICES
Entity Type:Organization
Organization Name:ORAL HEALTH & PREVENTIVE SERVICES
Other - Org Name:GRINOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:HYGIENIST
Authorized Official - Phone:509-303-9700
Mailing Address - Street 1:1900 FOWLER ST STE E
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4845
Mailing Address - Country:US
Mailing Address - Phone:509-303-9700
Mailing Address - Fax:509-572-2445
Practice Address - Street 1:1900 FOWLER ST STE E
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4845
Practice Address - Country:US
Practice Address - Phone:509-303-9700
Practice Address - Fax:509-572-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIL60466261251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health