| Grace Family Dental | |
|
1538 11th Ave Longview WA 98632-4123 | |
| (323) 804-1324 | |
| Not Available |
| Full Name | Grace Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 1538 11th Ave, Longview, Washington |
| Authorized Official Name and Position | Hamid Azizi (OWNER) |
| Authorized Official Contact | 3238041324 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Family Dental 3984 Nw Currawong Ct Camas WA 98607-8521 | Grace Family Dental 1538 11th Ave Longview WA 98632-4123 Ph: (323) 804-1324 |
| NPI Number | 1275259582 |
|---|---|
| Provider Enumeration Date | 10/18/2022 |
| Last Update Date | 10/18/2022 |
| Certification Date | 10/12/2022 |
| Medicare PECOS PAC ID | 4981071727 |
|---|---|
| Medicare Enrollment ID | O20221107003222 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275259582 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (NU) | Primary |
| Provider Name | Hamid Azizi |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1598200610 PECOS PAC ID: 5890162630 Enrollment ID: I20221107003237 |
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