Individual
DIANE THORSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDA, EFDA, PTDA
Contact information
Practice address
12711 SE MILL PLAIN BLVD, VANCOUVER, WA 98684-6053
(360) 896-4484
(360) 896-4489
Mailing address
12711 SE MILL PLAIN BLVD, VANCOUVER, WA 98684-6053
(360) 896-4484
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
CDA # 126323
OR
126800000X
Dental Assistant
Primary
XRAY/EFDA # A10170
OR
Other
Enumeration date
08/12/2006
Last updated
07/16/2007
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