# LAVINCE GROUP PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Yelm Prairie Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043591043
- **Authorized official:** JAMES VINCENT SHUCK (VP)
- **Authorized official phone:** (360) 458-7645

## Contact information

- **Practice address:** 202 FIRST STREET SOUTH,, YELM, WA 98597
- **Practice address phone:** (360) 458-7645
- **Practice address fax:** (360) 458-2745
- **Mailing address:** PO BOX 1568, YELM, WA 98597-1568
- **Mailing address phone:** (360) 458-7645
- **Mailing address fax:** (360) 458-2745

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DE00006408 | WA | Yes |

## Other

- **Enumeration date:** 09/02/2011
- **Last updated:** 09/25/2011