Provider Demographics
NPI:1659484244
Name:R-K HOLDINGS INC
Entity Type:Organization
Organization Name:R-K HOLDINGS INC
Other - Org Name:VANCOUVER DENTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DD
Authorized Official - Phone:360-892-7060
Mailing Address - Street 1:4804C NE THURSTON WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662
Mailing Address - Country:US
Mailing Address - Phone:360-892-7060
Mailing Address - Fax:
Practice Address - Street 1:4804C NE THURSTON WAY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662
Practice Address - Country:US
Practice Address - Phone:360-892-7060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000290122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5043955Medicaid