Organization
OLYMPIC DENTAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN M ANDERSON LD (OWNER)
(360) 736-0795
Entity
Organization
Contact information
Practice address
716 W MAIN ST, CENTRALIA, WA 98531-2847
(360) 736-0795
(360) 330-1637
Mailing address
716 W MAIN ST, CENTRALIA, WA 98531-2847
(360) 736-0795
(360) 330-1637
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1412978
UNITED CONCORDIA PROVIDER
WA
05
—
5038377
—
WA
Enumeration date
03/27/2007
Last updated
08/22/2020
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