| Columbia Basin Pediatric Dentistry | |
|
7501 W Deschutes Pl Kennewick WA 99336-7719 | |
| (509) 865-6175 | |
| Not Available |
| Full Name | Columbia Basin Pediatric Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 7501 W Deschutes Pl, Kennewick, Washington |
| Authorized Official Name and Position | Shannon Fernandez (BILLING VP) |
| Authorized Official Contact | 5088656175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbia Basin Pediatric Dentistry Po Box 190 Toppenish WA 98948-0190 Ph: (509) 865-6175 | Columbia Basin Pediatric Dentistry 7501 W Deschutes Pl Kennewick WA 99336-7719 Ph: (509) 865-6175 |
| NPI Number | 1144876905 |
|---|---|
| Provider Enumeration Date | 08/16/2019 |
| Last Update Date | 11/01/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144876905 | NPI | - | NPPES |
| 600304660 | Other | WA | BUSINESS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Secondary |
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