Provider Demographics
NPI:1396915500
Name:UNDERTHESEADENTISTRYFORCHILDREN
Entity type:Organization
Organization Name:UNDERTHESEADENTISTRYFORCHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-891-9283
Mailing Address - Street 1:3205 SE 192ND AVE
Mailing Address - Street 2:SUITE#100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-891-9283
Mailing Address - Fax:360-891-8030
Practice Address - Street 1:3205 SE 192ND AVE
Practice Address - Street 2:SUITE#100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1467
Practice Address - Country:US
Practice Address - Phone:360-891-9283
Practice Address - Fax:360-891-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000103551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty