# SPRINGFIELD KIDS DENTIST LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831603018
- **Authorized official:** FEMINA JANE BEDOLLA (OPERATIONS OFFICER)
- **Authorized official phone:** (541) 844-3113

## Contact information

- **Practice address:** 5895 MAIN ST, SPRINGFIELD, OR 97478-6961
- **Practice address phone:** (541) 654-4996
- **Practice address fax:** (541) 505-8463
- **Mailing address:** 5895 MAIN ST, SPRINGFIELD, OR 97478-6961
- **Mailing address phone:** (541) 654-4996
- **Mailing address fax:** (541) 505-8463

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | D8929 | OR | Yes |

## Other

- **Enumeration date:** 11/26/2017
- **Last updated:** 11/26/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1528268281 | PRIVATE INSURANCE | — |
| 05 | — | 279295 | — | OR |