Provider Demographics
NPI:1053409037
Name:FRANK F VEDELAGO DDS PS
Entity type:Organization
Organization Name:FRANK F VEDELAGO DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:FELIX
Authorized Official - Last Name:VEDELAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-326-8646
Mailing Address - Street 1:N 4610 N ASH #101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1482
Mailing Address - Country:US
Mailing Address - Phone:509-326-8646
Mailing Address - Fax:509-325-5334
Practice Address - Street 1:N 4610 N ASH #101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1482
Practice Address - Country:US
Practice Address - Phone:509-326-8646
Practice Address - Fax:509-325-5334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA28971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA173417OtherUNITED CONCORDIA
WA02679OtherWASH DENTAL SERVICE