PERIODONTAL CONCEPTS (NPI# 1205041514) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205041514 |
| Entity Type | Organization |
| Organization Name | PERIODONTAL CONCEPTS |
| Practice Address |
300 Se 120th Ave Ste 500 Vancouver WA 98683-4020 |
| Practice Telephone | 3602548151 |
| Practice Fax Number | 3602547175 |
| Mailing Telephone | 3602548151 |
| Mailing Fax Number | 3602547175 |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MUNIB Y. DERHALLI (PRESIDENT) |
| Authorized Official Telephone | 3602548151 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
DE7432 | WA | Dental Providers |
| Street Address |
300 SE 120TH AVE STE 500 |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98683-4020 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538239728 | Munib Y. Derhalli | Dentist | 300 Se 120th Ave Ste 500, Vancouver, WA 98683-4020 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235761222 | Nathaniel James Eugene Powell | Behavior Technician | 4101se 192nd Ave, Ste 101, Vancouver, WA 98683 | 2020-02-07 |
| 1295294973 | Ubmhc1, LLC | Clinical Medical Laboratory | 18110 Southeast 34th St, Building 2, Suite 240, Vancouver, WA 98683 | 2019-03-13 |
| 1982116695 | Amy K Adams | Massage Therapist | 2716 Se 169th Ave, X-232, Vancouver, WA 98683 | 2017-11-03 |
| 1477088920 | Alexandra Ransonet | Dental Hygienist | 19111 Se 34th. St., Vancouver, WA 98683 | 2017-04-21 |
| 1639618630 | Digestive Gi Care | Internal Medicine | 305 Sw Chkalov Dr, 111-140, Vancouver, WA 98683 | 2017-02-23 |
| 1447706742 | Jennifer Horst | Massage Therapist | 3401 Se 192nd. Ave. Suite 107, Vancouver, WA 98683 | 2016-08-28 |
| 1154702728 | Kacie Marie Hamreus | Physician Assistant | 3101 Se 192nd Avenue, Vancouver, WA 98683 | 2015-06-09 |
| 1851782338 | Kathryn Wiedeman | Physical Therapy Assistant | 801 Se Park Crestt Ave, Vancouver, WA 98683 | 2015-02-05 |
| 1407255326 | Jesse Ryan Moses | Dentist | 16600 Se 15th Street, Suite A, Vancouver, WA 98683 | 2014-08-15 |
| 1366869893 | Stephen J Wold II | Podiatrist | 16701 Ne Mcgillivray Blvd, Ste 220, Vancouver, WA 98683 | 2014-03-21 |
| Find all providers in zip 98683 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346478906 | Jeremy H Diehl, D.d.s., M.s.d., PC | Dentist | 2702 Ne 78th St, Suite 108, Vancouver, WA 98665-0665 | 2009-06-23 |
| 1538239728 | Munib Y. Derhalli | Dentist | 300 Se 120th Ave Ste 500, Vancouver, WA 98683-4020 | 2006-11-08 |
| 1154417491 | Steven David Hokett | Dentist | 14411 Ne 20th Ave Ste 111, Vancouver, WA 98686-6431 | 2006-10-05 |
| 1295844900 | Wendel Family Dental Centre Ps | Dentist | 7012 Ne 40th St, Vancouver, WA 98661-3052 | 2006-08-29 |
| 1578090932 | Ashwin Balakrishnan Nambisan | Dentist | 512 Ne 81st St Ste G, Vancouver, WA 98665-8134 | 2017-05-16 |
| 1356781496 | Colin Stuart Graser | Dentist | 14201 Ne 20th Ave Ste B200, Vancouver, WA 98686-6412 | 2013-07-03 |
| 1700164969 | Behnam Fakhravar | Dentist | 322 Se 192nd Ave Ste 100, Vancouver, WA 98683-9679 | 2011-07-21 |
| 1023248291 | Jeremy Howard Diehl | Dentist | 2702 Ne 78th St, Suite 108, Vancouver, WA 98665-0665 | 2009-07-21 |
| 1003936501 | Melissa Grant | Dentist | 7725 Ne Highway 99, Vancouver, WA 98665-8834 | 2007-03-29 |
| 1689713885 | Bob A Sonnes | Dentist | 406 Se 131st Ave, Ste 305c, Vancouver, WA 98683-4004 | 2007-02-05 |
| Find all providers in VANCOUVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.