NPIMap

Organization Active NPI

Clarkston Denturist Clinic

  • Denturist
  • Clarkston, WA
National Provider Identifier
1538487665
Registry record updated May 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DenturistTaxonomy code 122400000X
Legal business name
CLARKSTON DENTURIST CLINIC
Practice address
1346 12TH St
Clarkston, WA 99403-2821
Phone
(509) 758-7805
Fax
(509) 751-1510
NPI assigned
May 13, 2010
Last updated
May 13, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2010

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

Authorized official

Name
Mr. Eldred Donald Olson, L.D.
Title
Owner/Operator
Phone
(509) 758-7805

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Denturist 122400000X NU Primary

Addresses

Primary practice location

1346 12TH St
Clarkston, WA 99403-2821

Mailing address

1346 12TH St
Clarkston, WA 99403-2821
Phone (509) 758-7805

Other identifiers 1

IdentifierTypeStateIssuer
1003977091MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Cape Cod Anesthesia Associates456 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1346 12th St
Clarkston, WA 99403
Phone (509) 758-7805

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273708800000",
    "number": "1538487665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1346 12TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032821",
            "telephone_number": "509-758-7805",
            "fax_number": "509-751-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1346 12TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032821",
            "telephone_number": "509-758-7805",
            "fax_number": "509-751-1510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSTON DENTURIST CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-13",
        "last_updated": "2010-05-13",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "ELDRED",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "509-758-7805",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.D."
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003977091",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarkston, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.