1164898342 NPI number — SPECIAL DELIVERY DENTAL CARE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164898342 NPI number — SPECIAL DELIVERY DENTAL CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL DELIVERY DENTAL CARE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GERIATRIC DENTAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164898342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16500 SE 15TH ST STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-9667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-326-3829
Provider Business Mailing Address Fax Number:
360-326-4289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16500 SE 15TH ST STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98683-9667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-326-3829
Provider Business Practice Location Address Fax Number:
360-326-4289
Provider Enumeration Date:
08/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LINDER
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
360-326-3829

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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