Provider Demographics
NPI:1124438684
Name:VANCOUVER DENTAL SURGERY CENTER
Entity type:Organization
Organization Name:VANCOUVER DENTAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-604-9000
Mailing Address - Street 1:14411 NE 20TH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6431
Mailing Address - Country:US
Mailing Address - Phone:360-604-9000
Mailing Address - Fax:360-573-1417
Practice Address - Street 1:14411 NE 20TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6431
Practice Address - Country:US
Practice Address - Phone:360-604-9000
Practice Address - Fax:360-604-9000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEIL & HILLYARD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-05
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602806065261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical