| Republic Dental Clinic | |
|
194 N. Portland St. Republic WA 99166-0978 | |
| (509) 775-3169 | |
| (509) 775-2272 |
| Full Name | Republic Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 194 N. Portland St., Republic, Washington |
| Authorized Official Name and Position | Robert W. Hardwick (OWNER/DENTIST) |
| Authorized Official Contact | 5097753169 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Republic Dental Clinic Po Box 978 Republic WA 99166-0978 Ph: (509) 775-3169 | Republic Dental Clinic 194 N. Portland St. Republic WA 99166-0978 Ph: (509) 775-3169 |
| NPI Number | 1164749396 |
|---|---|
| Provider Enumeration Date | 04/28/2010 |
| Last Update Date | 04/28/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164749396 | NPI | - | NPPES |
| 5027230 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5070 (Washington) | Primary |