Organization
GOLDENDALE DENTAL CENTER INC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYLE E FERCH DDS (OWNER/DENTIST)
(509) 773-5545
Entity
Organization
Contact information
Practice address
617 E COLLINS ST, GOLDENDALE, WA 98620-9213
(509) 773-5545
(509) 773-6718
Mailing address
617 EAST COLLINS DR, GOLDENDALE, WA 98620
(509) 773-5545
(509) 773-6718
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00006589
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0105783
L&I PROVIDER #
WA
05
—
5013024
—
WA
Enumeration date
07/24/2006
Last updated
05/02/2012
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