Organization
CLARK COUNTY DENTAL & DENTURE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SALLY IRENE FETTIG (PRESIDENT)
(360) 892-7107
Entity
Organization
Contact information
Practice address
2701 NE 114TH AVE, # K-6, VANCOUVER, WA 98684-4289
(360) 892-7107
(360) 891-8361
Mailing address
2701 NE 114TH AVE, # K-6, VANCOUVER, WA 98684-4289
(360) 892-7107
(360) 891-8361
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
DN00000393
WA
122400000X
Denturist
Primary
DN0000195
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5026356
—
WA
05
—
5036074
—
WA
05
—
5041082
—
WA
05
—
5047576
—
WA
05
—
5048616
—
WA
Enumeration date
07/26/2006
Last updated
08/22/2020
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