Provider Demographics
NPI:1689348583
Name:WENATCHEE DENTAL ARTS
Entity Type:Organization
Organization Name:WENATCHEE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PS
Authorized Official - Phone:509-664-2920
Mailing Address - Street 1:417 N MISSION ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2007
Mailing Address - Country:US
Mailing Address - Phone:509-664-2920
Mailing Address - Fax:509-663-1453
Practice Address - Street 1:417 N MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2007
Practice Address - Country:US
Practice Address - Phone:509-664-2920
Practice Address - Fax:509-663-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery