1891790812 NPI number — BILLY DON CARD, JR., DDS, MS, PS

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 1891790812 NPI number — BILLY DON CARD, JR., DDS, MS, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILLY DON CARD, JR., DDS, MS, PS
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:
Provider Other Organization Name Type Code:
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:
1891790812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 N EMERSON AVE
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801-6619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-663-6883
Provider Business Mailing Address Fax Number:
509-662-8741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 N EMERSON AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-6619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-663-6883
Provider Business Practice Location Address Fax Number:
509-662-8741
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARD
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
DON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
509-663-6883

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  8590 , 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)

  • Identifier: 0141944 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 238 . This is a "WDS CLIENT #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8925622 . This is a "CRIME VICTIMS COMP. PROG." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: DE 00008590 . This is a "STATE DENTAL LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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