Provider Demographics
NPI:1881885945
Name:DENTURECARE, INC.
Entity type:Organization
Organization Name:DENTURECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLISPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-681-7089
Mailing Address - Street 1:124 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3350
Mailing Address - Country:US
Mailing Address - Phone:360-681-7089
Mailing Address - Fax:360-582-0138
Practice Address - Street 1:124 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3350
Practice Address - Country:US
Practice Address - Phone:360-681-7089
Practice Address - Fax:360-582-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000019122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Multi-Specialty