Organization
PERIODONTAL CONCEPTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUNIB Y. DERHALLI D.M.D. (PRESIDENT)
(360) 254-8151
Entity
Organization
Contact information
Practice address
300 SE 120TH AVE STE 500, VANCOUVER, WA 98683-4020
(360) 254-8151
(360) 254-7175
Mailing address
300 SE 120TH AVE STE 500, VANCOUVER, WA 98683-4020
(360) 254-8151
(360) 254-7175
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DE7432
WA
Other
Enumeration date
05/11/2007
Last updated
08/22/2020
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