Provider Demographics
NPI:1396126850
Name:DENTAL SERVICE, LLC
Entity type:Organization
Organization Name:DENTAL SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-571-8181
Mailing Address - Street 1:14201 NE 20TH AVE
Mailing Address - Street 2:SUITE 2204
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6410
Mailing Address - Country:US
Mailing Address - Phone:360-571-8181
Mailing Address - Fax:360-573-4022
Practice Address - Street 1:14201 NE 20TH AVE
Practice Address - Street 2:SUITE 2204
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6410
Practice Address - Country:US
Practice Address - Phone:360-571-8181
Practice Address - Fax:360-573-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005337261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental