# MOUNTAIN VIEW DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 1710101076
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1407320013
- **Legal business name:** 1710101076
- **Authorized official:** BENJAMIN CRUSAN DDS (DENTIST/OWNER)
- **Authorized official phone:** (360) 887-1177

## Contact information

- **Practice address:** 5284 PIONEER ST STE 120, RIDGEFIELD, WA 98642-3371
- **Practice address phone:** (360) 887-1177
- **Practice address fax:** (360) 887-1178
- **Mailing address:** 5284 PIONEER ST STE 120, RIDGEFIELD, WA 98642-3371
- **Mailing address phone:** (360) 887-1177
- **Mailing address fax:** (360) 887-1178

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2019
- **Last updated:** 08/10/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1710101076 | NON-MEDICAID | WA |