Provider Demographics
NPI:1013109115
Name:CANEPA DENTAL, LLC
Entity Type:Organization
Organization Name:CANEPA DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANEPA
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-514-0707
Mailing Address - Street 1:1405 SE 164TH AVE
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
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:360-514-0707
Practice Address - Fax:360-514-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000073721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty