# GOLDENDALE DENTAL CENTER INC PC

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

## Provider details

- **NPI number:** 1689696734
- **Authorized official:** DR. LYLE E FERCH DDS (OWNER/DENTIST)
- **Authorized official phone:** (509) 773-5545

## Contact information

- **Practice address:** 617 E COLLINS ST, GOLDENDALE, WA 98620-9213
- **Practice address phone:** (509) 773-5545
- **Practice address fax:** (509) 773-6718
- **Mailing address:** 617 EAST COLLINS DR, GOLDENDALE, WA 98620
- **Mailing address phone:** (509) 773-5545
- **Mailing address fax:** (509) 773-6718

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00006589 | WA | Yes |

## Other

- **Enumeration date:** 07/24/2006
- **Last updated:** 05/02/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0105783 | L&I PROVIDER \# | WA |
| 05 | — | 5013024 | — | WA |