Provider Demographics
NPI:1861735565
Name:VANCOUVER DENTAL CARE, L.L.C.
Entity type:Organization
Organization Name:VANCOUVER DENTAL CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-506-1913
Mailing Address - Street 1:1418 NE 78TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9631
Mailing Address - Country:US
Mailing Address - Phone:360-450-0075
Mailing Address - Fax:360-719-2314
Practice Address - Street 1:1418 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9631
Practice Address - Country:US
Practice Address - Phone:360-450-0075
Practice Address - Fax:360-719-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600854791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty