| Main Street Family Dentistry | |
|
3512 Main St Vancouver WA 98663-2224 | |
| (360) 696-2513 | |
| Not Available |
| Full Name | Main Street Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3512 Main St, Vancouver, Washington |
| Authorized Official Name and Position | Jessica Miller (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 3606962513 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Dentistry 3512 Main St Vancouver WA 98663-2224 Ph: (360) 696-2513 | Main Street Family Dentistry 3512 Main St Vancouver WA 98663-2224 Ph: (360) 696-2513 |
| NPI Number | 1083291405 |
|---|---|
| Provider Enumeration Date | 03/24/2021 |
| Last Update Date | 03/24/2021 |
| Certification Date | 03/24/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083291405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Primary |
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