# GRESHAM FAMILY DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sleep Dentistry of Vancouver -East
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760214357
- **Authorized official:** LAVERNE A BLAIR (INSURANCE COORDINATOR)
- **Authorized official phone:** (360) 892-7107

## Contact information

- **Practice address:** 1821 SE 192ND AVE STE 200, CAMAS, WA 98607-6507
- **Practice address phone:** (360) 852-8515
- **Mailing address:** 1821 SE 192ND AVE STE 200, CAMAS, WA 98607-6507
- **Mailing address phone:** (360) 852-8515

## Taxonomy

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

## Other

- **Enumeration date:** 08/14/2024
- **Last updated:** 08/14/2024