| Tri-cities Periodontics & Implants | |
|
7409 W Grandridge Blvd Suite B Kennewick WA 99336-6710 | |
| (509) 783-5722 | |
| (509) 735-2822 |
| Full Name | Tri-cities Periodontics & Implants |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7409 W Grandridge Blvd, Kennewick, Washington |
| Authorized Official Name and Position | Howard Kirby Skavdahl (OWNER) |
| Authorized Official Contact | 5097835722 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-cities Periodontics & Implants 7409 W Grandridge Blvd Suite B Kennewick WA 99336-6710 Ph: (509) 783-5722 | Tri-cities Periodontics & Implants 7409 W Grandridge Blvd Suite B Kennewick WA 99336-6710 Ph: (509) 783-5722 |
| NPI Number | 1588017636 |
|---|---|
| Provider Enumeration Date | 07/13/2016 |
| Last Update Date | 07/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588017636 | NPI | - | NPPES |
| 1245368604 | Other | INDIVIDUAL NPI # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5324 (Washington) | Primary |
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