Provider Demographics
NPI:1952571382
Name:VANCOUVER CENTER FOR GENERAL AND COSMETIC DENTISTRY
Entity type:Organization
Organization Name:VANCOUVER CENTER FOR GENERAL AND COSMETIC DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIPES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-699-5555
Mailing Address - Street 1:6715 NE 63RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1980
Mailing Address - Country:US
Mailing Address - Phone:360-699-5555
Mailing Address - Fax:360-699-8999
Practice Address - Street 1:6715 NE 63RD ST STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1980
Practice Address - Country:US
Practice Address - Phone:360-699-5555
Practice Address - Fax:360-699-8999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty