| Southridge Dental | |
|
3911 W 27th Ave Ste 105 Kennewick WA 99337-2483 | |
| (509) 581-0081 | |
| Not Available |
| Full Name | Southridge Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3911 W 27th Ave Ste 105, Kennewick, Washington |
| Authorized Official Name and Position | Eric Winterton (DENTIST) |
| Authorized Official Contact | 5095810081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southridge Dental 3911 W 27th Ave Ste 105 Kennewick WA 99337-2483 Ph: (509) 581-0081 | Southridge Dental 3911 W 27th Ave Ste 105 Kennewick WA 99337-2483 Ph: (509) 581-0081 |
| NPI Number | 1215326202 |
|---|---|
| Provider Enumeration Date | 01/14/2015 |
| Last Update Date | 01/14/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215326202 | NPI | - | NPPES |
| 2038359 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DE60232632 (Washington) | Primary |
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