NPIMap

Organization Active NPI

Kamilche Dental Center

  • Dentist
  • Shelton, WA
National Provider Identifier
1043379480
Registry record updated Aug 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE00008865 Issued in WA
Legal business name
KAMILCHE DENTAL CENTER
Practice address
3100 SE Old Olympic Hwy
Shelton, WA 98584-7731
Phone
(360) 427-1784
Fax
(360) 427-1818
NPI assigned
Dec 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2012

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

Authorized official

Name
Mr. Steven R Peters, LISCENSED DENTURISTNPI 1215000666
Title
Owner
Phone
(360) 427-1784

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DE00008865 WA Primary
DenturistGroup: 193200000X MULTI-SPECIALTY GROUP 122400000X DN0000036 WA
DenturistGroup: 193200000X MULTI-SPECIALTY GROUP 122400000X DN00000236 WA

Addresses

Primary practice location

3100 SE Old Olympic Hwy
Shelton, WA 98584-7731

Mailing address

3100 SE Old Olympic Hwy
Shelton, WA 98584-7731
Phone (360) 427-1784

Other identifiers 1

IdentifierTypeStateIssuer
5040365MedicaidWA

National Provider Directory

National Provider Directory

Locations

3100 SE Old Olympic Hwy
Shelton, WA 98584
Phone (360) 427-1784

Practitioners & affiliated clinicians

Practitioners 5

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": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344297600000",
    "number": "1043379480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SE OLD OLYMPIC HWY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985847731",
            "telephone_number": "360-427-1784",
            "fax_number": "360-427-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SE OLD OLYMPIC HWY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985847731",
            "telephone_number": "360-427-1784",
            "fax_number": "360-427-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAMILCHE DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2012-08-07",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-427-1784",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LISCENSED DENTURIST"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00008865",
            "primary": true
        },
        {
            "code": "122400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Denturist",
            "state": "WA",
            "license": "DN0000036",
            "primary": false
        },
        {
            "code": "122400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Denturist",
            "state": "WA",
            "license": "DN00000236",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5040365",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; 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.