Organization
CLARKSTON DENTURIST CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELDRED DONALD OLSON L.D. (OWNER/OPERATOR)
(509) 758-7805
Entity
Organization
Contact information
Practice address
1346 12TH ST, CLARKSTON, WA 99403-2821
(509) 758-7805
(509) 751-1510
Mailing address
1346 12TH ST, CLARKSTON, WA 99403-2821
(509) 758-7805
(509) 751-1510
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003977091
—
WA
Enumeration date
05/13/2010
Last updated
05/13/2010
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