Organization
HILANDER DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE JEANETTE KJOSE (MANAGER/CONTROLLER)
(360) 636-5170
Entity
Organization
Contact information
Practice address
510 ALLEN ST, KELSO, WA 98626-4139
(360) 636-5170
(636) 636-0052
Mailing address
510 ALLEN ST, KELSO, WA 98626-4139
(360) 636-5170
(636) 636-0052
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5035936
—
WA
Enumeration date
08/10/2010
Last updated
12/23/2020
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