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Organization
VICTOR IMMEL, DMD, PS
Active
Organization
VICTOR IMMEL, DMD, PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR D IMMEL DMD (DIRECT OWNER)
(509) 457-5387
Entity
Organization
Contact information
Practice address
1506 SUMMITVIEW AVE, YAKIMA, WA 98902-2943
(509) 457-5387
(509) 457-6580
Mailing address
1506 SUMMITVIEW AVE, YAKIMA, WA 98902-2943
(509) 457-5387
(509) 457-6580
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6921
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128266
LABOR AND INDUSTRIES
WA
01
—
5032222
DSHS
WA
01
—
9643
WDS
WA
01
—
IM1280
BLUE SHIELD
WA
Enumeration date
10/03/2006
Last updated
08/22/2020
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