Provider Demographics
NPI:1013049394
Name:CENTRAL WA ORAL HEALTH FOUNDATION
Entity Type:Organization
Organization Name:CENTRAL WA ORAL HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-966-0303
Mailing Address - Street 1:103 S 3RD ST
Mailing Address - Street 2:SUITE #204
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2883
Mailing Address - Country:US
Mailing Address - Phone:509-248-1305
Mailing Address - Fax:509-574-4250
Practice Address - Street 1:103 S 3RD ST
Practice Address - Street 2:SUITE #204
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2883
Practice Address - Country:US
Practice Address - Phone:509-248-1305
Practice Address - Fax:509-574-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA15162251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036082Medicaid