Provider Demographics
NPI:1285718841
Name:DOUGLAS TOPPER WILSON MILLER AND BOSSHARDT PS
Entity type:Organization
Organization Name:DOUGLAS TOPPER WILSON MILLER AND BOSSHARDT PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:509-965-8911
Mailing Address - Street 1:4207 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3347
Mailing Address - Country:US
Mailing Address - Phone:509-965-8911
Mailing Address - Fax:509-965-6143
Practice Address - Street 1:4207 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3347
Practice Address - Country:US
Practice Address - Phone:509-965-8911
Practice Address - Fax:509-965-6143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5028519Medicaid