Individual
DR. BRIAN BENASA BARDELOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
605 SE 164TH AVE STE 103, VANCOUVER, WA 98684
(360) 882-0222
Mailing address
14201 NE 20TH AVE STE B200, VANCOUVER, WA 98686-6412
(360) 571-8181
(360) 573-4022
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D10817
OR
1223G0001X
General Practice Dentistry
Primary
DE60876885
WA
Other
Enumeration date
07/19/2017
Last updated
09/14/2018
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