Provider Demographics
NPI:1013091776
Name:OJH CLINIC NO 5 INC.-BURLINGTON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:OJH CLINIC NO 5 INC.-BURLINGTON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-755-5600
Mailing Address - Street 1:1250 S BURLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3316
Mailing Address - Country:US
Mailing Address - Phone:360-755-7566
Mailing Address - Fax:360-755-9384
Practice Address - Street 1:1250 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3316
Practice Address - Country:US
Practice Address - Phone:360-755-7566
Practice Address - Fax:360-755-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty