Individual
DR. GEORGE RUSSELL CHURCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1412 NE 134TH ST, SUITE 140, VANCOUVER, WA 98685-2719
(360) 574-4007
(360) 574-8516
Mailing address
1412 NE 134TH ST, SUITE 140, VANCOUVER, WA 98685-2719
(360) 574-4007
(360) 574-8516
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6155
WA
Other
Enumeration date
07/07/2007
Last updated
07/08/2007
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