Organization
LAVINCE GROUP PS
Active
Other names
Yelm Prairie Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES VINCENT SHUCK (VP)
(360) 458-7645
Entity
Organization
Contact information
Practice address
202 FIRST STREET SOUTH,, YELM, WA 98597
(360) 458-7645
(360) 458-2745
Mailing address
PO BOX 1568, YELM, WA 98597-1568
(360) 458-7645
(360) 458-2745
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DE00006408
WA
Other
Enumeration date
09/02/2011
Last updated
09/25/2011
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