Provider Demographics
NPI:1629228960
Name:ACCESS DENTAL PLAN LLC
Entity Type:Organization
Organization Name:ACCESS DENTAL PLAN LLC
Other - Org Name:ACCESS DENTAL PLAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-571-8181
Mailing Address - Street 1:14201 NE 20TH AVE
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6410
Mailing Address - Country:US
Mailing Address - Phone:360-571-8181
Mailing Address - Fax:360-573-4022
Practice Address - Street 1:14201 NE 20TH AVE
Practice Address - Street 2:SUITE 2204
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6410
Practice Address - Country:US
Practice Address - Phone:360-571-8181
Practice Address - Fax:360-573-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty