| White Swan Dental Clnic | |
|
62 Bird Song Lane White Swan WA 98952 | |
| (509) 874-2028 | |
| Not Available |
| Full Name | White Swan Dental Clnic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 62 Bird Song Lane, White Swan, Washington |
| Authorized Official Name and Position | Jay Sampson (CEO) |
| Authorized Official Contact | 5098652102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| White Swan Dental Clnic Po Box 693 White Swan WA 87841 Ph: (509) 865-2102 | White Swan Dental Clnic 62 Bird Song Lane White Swan WA 98952 Ph: (509) 874-2028 |
| NPI Number | 1245378389 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245378389 | NPI | - | NPPES |
| 7100506 | Medicaid | WA | |
| 21940 | Other | WA | LABOR & INDSTRY MED # |
| 51239 | Other | WA | LABOR & INDSTRY RX # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |