NPIMap

Organization Active NPI

Tri-Star Denture Clinic

  • Denturist
  • Vancouver, WA
National Provider Identifier
1407176993
Registry record updated Jun 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DenturistTaxonomy code 122400000X
License
DN00000394 Issued in WA
Legal business name
TRI-STAR DENTURE CLINIC
Practice address
2802 Columbia St
Vancouver, WA 98660-2220
Phone
(360) 906-0015
Fax
(360) 906-0023
NPI assigned
Jun 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2010

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

Authorized official

Name
Mr. Lenard Gobin Deochand, LD, DDNPI 1386782282
Title
Denturist
Phone
(360) 906-0015

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X WA00008442 WA
DenturistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122400000X DN00000394 WA Primary

Addresses

Primary practice location

2802 Columbia St
Vancouver, WA 98660-2220

Mailing address

2802 Columbia St
Vancouver, WA 98660-2220
Phone (360) 906-0015

Other identifiers 2

IdentifierTypeStateIssuer
278500MedicaidOR
5047667MedicaidWA

National Provider Directory

National Provider Directory

Locations

2802 Columbia St
Vancouver, WA 98660
Phone (360) 906-0015

Practitioners & affiliated clinicians

Practitioners 1

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": "1275868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275868800000",
    "number": "1407176993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2802 COLUMBIA ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986602220",
            "telephone_number": "360-906-0015",
            "fax_number": "360-906-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2802 COLUMBIA ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986602220",
            "telephone_number": "360-906-0015",
            "fax_number": "360-906-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STAR DENTURE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-07",
        "last_updated": "2010-06-07",
        "status": "A",
        "authorized_official_last_name": "DEOCHAND",
        "authorized_official_first_name": "LENARD",
        "authorized_official_middle_name": "GOBIN",
        "authorized_official_title_or_position": "DENTURIST",
        "authorized_official_telephone_number": "360-906-0015",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LD, DD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "WA00008442",
            "primary": false
        },
        {
            "code": "122400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Denturist",
            "state": "WA",
            "license": "DN00000394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278500",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5047667",
            "state": "WA"
        }
    ],
    "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 Jun 7, 2010; 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.