Provider Demographics
NPI:1497209985
Name:EASTMONT FAMILY DENTAL
Entity Type:Organization
Organization Name:EASTMONT FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-886-2345
Mailing Address - Street 1:801 EASTMONT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-7665
Mailing Address - Country:US
Mailing Address - Phone:509-886-2345
Mailing Address - Fax:509-886-2611
Practice Address - Street 1:801 EASTMONT AVE STE A
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-7665
Practice Address - Country:US
Practice Address - Phone:509-886-2345
Practice Address - Fax:509-886-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty