Provider Demographics
NPI:1699422386
Name:RENEE SHEELER DENTURE CLINIC, INC
Entity type:Organization
Organization Name:RENEE SHEELER DENTURE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTZALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-575-1667
Mailing Address - Street 1:205 PACIFIC AVE N
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-3413
Mailing Address - Country:US
Mailing Address - Phone:360-575-1667
Mailing Address - Fax:
Practice Address - Street 1:205 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3413
Practice Address - Country:US
Practice Address - Phone:360-575-1667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty