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Organization
CASCADE KIDS DENTAL
Active
Organization
CASCADE KIDS DENTAL
Active
Other names
Zooka Super Toothcare For Kids
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REX SHANNON GIBSON DDS (OWNER)
(541) 318-5688
Entity
Organization
Contact information
Practice address
572 SW BLUFF DR, STE A, BEND, OR 97702-1260
(541) 318-5688
(541) 322-5581
Mailing address
572 SW BLUFF DR, STE A, BEND, OR 97702-1260
(541) 318-5688
(541) 322-5581
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D7724
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
299183
—
OR
Enumeration date
08/10/2005
Last updated
08/22/2020
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