Provider Demographics
NPI:1790874899
Name:CANEPA, ALBERT B III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:B
Last Name:CANEPA
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SE 164TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9644
Mailing Address - Country:US
Mailing Address - Phone:360-514-0707
Mailing Address - Fax:360-514-9395
Practice Address - Street 1:1405 SE 164TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9644
Practice Address - Country:US
Practice Address - Phone:503-284-6469
Practice Address - Fax:503-288-0842
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00073721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice