| NPI | 1144876905 |
|---|---|
| Doing Business As | COLUMBIA BASIN PEDIATRIC DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SHANNON FERNANDEZ Billing VP 508-865-6175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2022-11-01 |