| Walla Walla Pediatric Dentistry | |
|
614 E Alder St Suite 6 Walla Walla WA 99362-2073 | |
| (509) 522-0555 | |
| Not Available |
| Full Name | Walla Walla Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 614 E Alder St, Walla Walla, Washington |
| Authorized Official Name and Position | Stacey Rae Kutsch (OWNER PEDIATRIC DENTIST) |
| Authorized Official Contact | 5093782520 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Walla Walla Pediatric Dentistry 614 E Alder St Suite 6 Walla Walla WA 99362-2073 Ph: (509) 522-0555 | Walla Walla Pediatric Dentistry 614 E Alder St Suite 6 Walla Walla WA 99362-2073 Ph: (509) 522-0555 |
| NPI Number | 1629491766 |
|---|---|
| Provider Enumeration Date | 01/25/2014 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629491766 | NPI | - | NPPES |
| CS10000430 | Other | WA | CONSCIOUS SEDATION PERMIT |
| 5050265 | Medicaid | WA | |
| DE00010428 | Other | WA | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | DE00010428 (Washington) | Primary |
| 261QD0000X | Clinic/center - Dental | DE00010428 (Washington) | Secondary |
Blue Mountain Dental Care Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1545 Business One Cir, Walla Walla, WA 99362 Phone: 509-525-4662 Fax: 509-525-0513 | |
Cecil S. Ash Dds, Ps Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 312 S 3rd Ave, Walla Walla, WA 99362 Phone: 509-529-3760 | |
Dr. Richard J. Sundberg D.d.s., P.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 S 3rd Ave, Walla Walla, WA 99362 Phone: 509-529-3762 Fax: 509-529-7622 | |
Edwards & Choi Dds, Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 614 E. Alder St., Suite #3, Walla Walla, WA 99362 Phone: 509-526-7012 Fax: 509-526-7013 | |
Walla Walla Orthodontics Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1608 Penny Ln, Walla Walla, WA 99362 Phone: 509-525-7030 Fax: 509-522-3704 | |
Antonio D. Caso, D.d.s., P.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 S 3rd Ave, Walla Walla, WA 99362 Phone: 509-529-3760 Fax: 509-529-7622 | |
Aria Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1648 Plaza Way, Walla Walla, WA 99362 Phone: 509-522-2220 Fax: 509-522-0171 |