Provider Demographics
NPI:1477767333
Name:OJH CLINIC NO 1 INC
Entity Type:Organization
Organization Name:OJH CLINIC NO 1 INC
Other - Org Name:COVINGTON FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-630-4400
Mailing Address - Street 1:17224 SE 272ND STREET
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042
Mailing Address - Country:US
Mailing Address - Phone:253-630-4400
Mailing Address - Fax:253-631-2267
Practice Address - Street 1:17224 SE 272ND STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042
Practice Address - Country:US
Practice Address - Phone:253-630-4400
Practice Address - Fax:253-631-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
52621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty