Provider Demographics
NPI:1407320013
Name:MOUNTAIN VIEW DENTAL
Entity Type:Organization
Organization Name:MOUNTAIN VIEW DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUSAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-887-1177
Mailing Address - Street 1:2 S 56TH PL STE 202
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-3427
Mailing Address - Country:US
Mailing Address - Phone:360-887-1177
Mailing Address - Fax:
Practice Address - Street 1:2 S 56TH PL STE 202
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3427
Practice Address - Country:US
Practice Address - Phone:360-887-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1710101076
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty