Provider Demographics
NPI:1871081778
Name:VASH DENTAL LLC
Entity type:Organization
Organization Name:VASH DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EPDH
Authorized Official - Prefix:
Authorized Official - First Name:LILIYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IGNASHOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-502-0701
Mailing Address - Street 1:623 NE 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:623 NE 160TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5702
Practice Address - Country:US
Practice Address - Phone:503-502-0701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4218125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty