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Individual

KENT LARGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
617 E COLLINS ST, GOLDENDALE, WA 98620-9213
(509) 773-5545
Mailing address
152 EAGLE DR, GOLDENDALE, WA 98620-3320
(360) 301-9561

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
D10641
OR
122300000X
Dentist
Primary
DE60748917
WA

Other

Enumeration date
06/20/2017
Last updated
10/30/2019
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