Organization
IMHOLTE & ANDERSON PLLC
Active
Other names
Twin City Dental
Organization subpart
No
Provider details
NPI number
Authorized official
PENNIE LYN BROYLES (OFFICE MANAGER)
(360) 577-1153
Entity
Organization
Contact information
Practice address
409 WEST MAIN STREET, KELSO, WA 98626
(360) 577-1153
(360) 425-1540
Mailing address
409 WEST MAIN STREET, KELSO, WA 98626
(360) 577-1153
(360) 425-1540
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4754
WA
1223G0001X
General Practice Dentistry
8788
WA
Other
Enumeration date
08/29/2006
Last updated
08/22/2020
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