NPIMap

Organization Active NPI

Serenity Dental

  • General Practice Dentistry
  • Vancouver, WA
National Provider Identifier
1013311729
Registry record updated Oct 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SERENITY DENTAL
Practice address
6614 E Mill Plain Blvd
Vancouver, WA 98661-7458
Phone
(360) 696-0471
Fax
(360) 993-8881
NPI assigned
Oct 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Supriya Goverdhanam, BDS,MS
Title
Owner
Phone
(360) 696-0471

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

6614 E Mill Plain Blvd
Vancouver, WA 98661-7458

Mailing address

6614 E Mill Plain Blvd
Vancouver, WA 98661-7458
Phone (360) 696-0471

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412812800000",
    "number": "1013311729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6614 E MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617458",
            "telephone_number": "360-696-0471",
            "fax_number": "360-993-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6614 E MILL PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617458",
            "telephone_number": "360-696-0471",
            "fax_number": "360-993-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-09",
        "last_updated": "2014-10-09",
        "status": "A",
        "authorized_official_last_name": "GOVERDHANAM",
        "authorized_official_first_name": "SUPRIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-696-0471",
        "authorized_official_credential": "BDS,MS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.