# VICTOR IMMEL, DMD, PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366536534
- **Authorized official:** DR. VICTOR D IMMEL DMD (DIRECT OWNER)
- **Authorized official phone:** (509) 457-5387

## Contact information

- **Practice address:** 1506 SUMMITVIEW AVE, YAKIMA, WA 98902-2943
- **Practice address phone:** (509) 457-5387
- **Practice address fax:** (509) 457-6580
- **Mailing address:** 1506 SUMMITVIEW AVE, YAKIMA, WA 98902-2943
- **Mailing address phone:** (509) 457-5387
- **Mailing address fax:** (509) 457-6580

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6921 | WA | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 08/22/2020

## 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 |