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Organization
CREEKSIDE DENTAL ELLENSBURG PLLC
Active
Organization
CREEKSIDE DENTAL ELLENSBURG PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LESLEE R THYSELL (TEMP OFC MGR)
(509) 577-8279
Entity
Organization
Contact information
Practice address
2601 TRIPLE L LOOP, ELLENSBURG, WA 98926
(509) 933-4800
Mailing address
2601 TRIPLE L LOOP, ELLENSBURG, WA 98926
(509) 933-4800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7703
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NONE YET
—
WA
Enumeration date
12/17/2009
Last updated
12/17/2009
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