Provider Demographics
NPI:1841445350
Name:COUPEVILLE DENTAL CLINIC
Entity type:Organization
Organization Name:COUPEVILLE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-678-8304
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0338
Mailing Address - Country:US
Mailing Address - Phone:360-678-8304
Mailing Address - Fax:
Practice Address - Street 1:107 S MAIN ST
Practice Address - Street 2:C 103
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3541
Practice Address - Country:US
Practice Address - Phone:360-678-8304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE0007688261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center