Organization
OLYMPIC DENTAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN ANDERSON D.P.D (DENTURIST)
(360) 438-8299
Entity
Organization
Contact information
Practice address
4408 PACIFIC AVE SE, LACEY, WA 98503-1119
(360) 438-8299
(360) 438-1399
Mailing address
4408 PACIFIC AVE SE, LACEY, WA 98503-1119
(360) 438-8299
(360) 438-1399
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1412978
UNITED CONCORDIA
WA
05
—
5040258
—
WA
Enumeration date
01/10/2007
Last updated
08/22/2020
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