Provider Demographics
NPI:1386924090
Name:CAREONE DENTAL
Entity type:Organization
Organization Name:CAREONE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-213-9824
Mailing Address - Street 1:13510 NE 84TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3092
Mailing Address - Country:US
Mailing Address - Phone:360-213-9824
Mailing Address - Fax:360-896-6264
Practice Address - Street 1:10555 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-2374
Practice Address - Country:US
Practice Address - Phone:971-266-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE81591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty