| Zooka Super Toothcare For Kids | |
|
572 Sw Bluff Dr Ste A Bend OR 97702-1260 | |
| (541) 318-5688 | |
| (541) 322-5581 |
| Full Name | Zooka Super Toothcare For Kids |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 572 Sw Bluff Dr, Bend, Oregon |
| Authorized Official Name and Position | Rex Shannon Gibson (OWNER) |
| Authorized Official Contact | 5413185688 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Zooka Super Toothcare For Kids 572 Sw Bluff Dr Ste A Bend OR 97702-1260 Ph: (541) 318-5688 | Zooka Super Toothcare For Kids 572 Sw Bluff Dr Ste A Bend OR 97702-1260 Ph: (541) 318-5688 |
| NPI Number | 1992706055 |
|---|---|
| Provider Enumeration Date | 08/10/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992706055 | NPI | - | NPPES |
| 299183 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D7724 (Oregon) | Primary |
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