Organization
ELEVEN ELEVEN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY L BIRCH DDS (PRESIDENT/OWNER)
(360) 457-3183
Entity
Organization
Contact information
Practice address
1111 COLUMBIA ST, PORT ANGELES, WA 98362-4207
(360) 457-3183
Mailing address
1111 COLUMBIA ST, PORT ANGELES, WA 98362-4207
(360) 457-3183
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
602789281
WA
Other
Enumeration date
09/25/2008
Last updated
09/25/2008
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