Individual
RICHARD R IMHOLTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
409 W MAIN ST, TWIN CITY DENTAL, KELSO, WA 98626-1117
(360) 577-1153
(360) 425-1540
Mailing address
409 W MAIN ST, TWIN CITY DENTAL, KELSO, WA 98626-1117
(360) 577-1153
(360) 425-1540
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4754
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5500905
WA STATE D.S.H.S.
WA
Enumeration date
04/03/2007
Last updated
07/08/2007
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