Organization
GREEN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRISH NIERMAN (OFFICE MANAGER)
(509) 662-8815
Entity
Organization
Contact information
Practice address
1008 5TH ST, WENATCHEE, WA 98801-1823
(509) 662-8815
(509) 667-8725
Mailing address
1008 5TH ST, WENATCHEE, WA 98801-1823
(509) 662-8815
(509) 667-8725
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
60022722
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60022722
DENTAL LICENSE
WA
Enumeration date
07/13/2016
Last updated
07/13/2016
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