Provider Demographics
NPI:1811295827
Name:LA VINCE GROUP, P.S DBA
Entity type:Organization
Organization Name:LA VINCE GROUP, P.S DBA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-458-7645
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-1568
Mailing Address - Country:US
Mailing Address - Phone:360-458-7645
Mailing Address - Fax:360-458-2745
Practice Address - Street 1:202 FIRST STREET SOUTH
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-1568
Practice Address - Country:US
Practice Address - Phone:360-458-7645
Practice Address - Fax:360-458-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty