Provider Demographics
NPI:1386782282
Name:DEOCHAND, LENARD GOBIN
Entity type:Individual
Prefix:MR
First Name:LENARD
Middle Name:GOBIN
Last Name:DEOCHAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2220
Mailing Address - Country:US
Mailing Address - Phone:360-906-0015
Mailing Address - Fax:360-906-0023
Practice Address - Street 1:2802 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2220
Practice Address - Country:US
Practice Address - Phone:360-906-0015
Practice Address - Fax:360-906-0023
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5047667Medicaid
WA8942843OtherCRIME VICTIM COMP. PROGRA
OR278500Medicaid