Provider Demographics
NPI:1295164333
Name:BRIAN C. ALDER, DDS, PC
Entity type:Organization
Organization Name:BRIAN C. ALDER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CALL
Authorized Official - Last Name:ALDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-574-8700
Mailing Address - Street 1:8700 NE HAZEL DELL AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8067
Mailing Address - Country:US
Mailing Address - Phone:360-574-8700
Mailing Address - Fax:360-573-8008
Practice Address - Street 1:8700 NE HAZEL DELL AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8067
Practice Address - Country:US
Practice Address - Phone:360-574-8700
Practice Address - Fax:360-573-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment