Provider Demographics
NPI:1922146042
Name:JAY K LANGSDORF, D.M.D. PS
Entity Type:Organization
Organization Name:JAY K LANGSDORF, D.M.D. PS
Other - Org Name:DBA CASCADE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-892-2994
Mailing Address - Street 1:16703 SE MCGILLIVRAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4300
Mailing Address - Country:US
Mailing Address - Phone:360-892-2994
Mailing Address - Fax:360-892-3929
Practice Address - Street 1:16703 SE MCGILLIVRAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4300
Practice Address - Country:US
Practice Address - Phone:360-892-2994
Practice Address - Fax:360-892-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty