Eleven Eleven Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

602789281 Issued in WA

Legal business name

ELEVEN ELEVEN DENTAL

Practice address

1111 Columbia St
Port Angeles, WA 98362-4207

Phone

(360) 457-3183

NPI assigned

Sep 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Gregory L Birch, DDS

Title

President/Owner

Phone

(360) 457-3183

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222300800000",
    "number": "1073763041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 COLUMBIA ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983624207",
            "telephone_number": "360-457-3183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 COLUMBIA ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983624207",
            "telephone_number": "360-457-3183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVEN ELEVEN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-25",
        "last_updated": "2008-09-25",
        "status": "A",
        "authorized_official_last_name": "BIRCH",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "360-457-3183",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "602789281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Edlund
• Elgita Eglite-Wilson, LMT
• Kenneth Eisenberger, LICSW, DCSW
• Mark A Eisenstadt, MD
• Morsy El Samaluty, RPH
• Audrey R Elias, P.T.
• Laura Lee Eliason, LMHCA
• Caren Ellington, NP-C
• Erin Elizabeth Ellison, MD
• Richard Thomas Elmer, DDS

• Dental Clinic/Center in Port Angeles, WA
• Providers in Port Angeles, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2008; 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.