Provider Demographics
NPI:1770849838
Name:WEST COAST ENDODONTICS, PC
Entity Type:Organization
Organization Name:WEST COAST ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:H
Authorized Official - Last Name:VY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-762-2500
Mailing Address - Street 1:9907 SE DIVISION STREET
Mailing Address - Street 2:STE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266
Mailing Address - Country:US
Mailing Address - Phone:503-762-2500
Mailing Address - Fax:503-762-2504
Practice Address - Street 1:9907 SE DIVISION STREET
Practice Address - Street 2:STE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:87266
Practice Address - Country:US
Practice Address - Phone:503-762-2500
Practice Address - Fax:503-762-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD76311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty