NPIMap

Organization Active NPI

Goldendale Dental Center Inc PC

  • General Practice Dentistry
  • Goldendale, WA
National Provider Identifier
1689696734
Registry record updated May 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00006589 Issued in WA
Legal business name
GOLDENDALE DENTAL CENTER INC PC
Practice address
617 E Collins St
Goldendale, WA 98620-9213
Phone
(509) 773-5545
Fax
(509) 773-6718
NPI assigned
Jul 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2012

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

Authorized official

Name
Dr. Lyle E Ferch, DDSNPI 1306104930
Title
Owner/Dentist
Phone
(509) 773-5545

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DE00006589 WA Primary

Addresses

Primary practice location

617 E Collins St
Goldendale, WA 98620-9213

Mailing address

617 East Collins Dr
Goldendale, WA 98620
Phone (509) 773-5545

Other identifiers 2

IdentifierTypeStateIssuer
0105783OtherWAL&I PROVIDER #
5013024MedicaidWA

National Provider Directory

National Provider Directory

Locations

617 E Collins St
Goldendale, WA 98620
Phone (509) 773-5545

Practitioners & affiliated clinicians

Practitioners 2

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": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335916800000",
    "number": "1689696734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 EAST COLLINS DR",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "98620",
            "telephone_number": "509-773-5545",
            "fax_number": "509-773-6718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 E COLLINS ST",
            "city": "GOLDENDALE",
            "state": "WA",
            "postal_code": "986209213",
            "telephone_number": "509-773-5545",
            "fax_number": "509-773-6718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDENDALE DENTAL CENTER INC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2012-05-02",
        "status": "A",
        "authorized_official_last_name": "FERCH",
        "authorized_official_first_name": "LYLE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "509-773-5545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00006589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER #",
            "identifier": "0105783",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5013024",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldendale, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.