Organization
HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
Active
Other names
Advanced Pediatric Dentistry of Walla Walla, Craik Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MELLISSA RENNER (REGIONAL OPERATIONS MANAGER)
(541) 667-4145
Entity
Organization
Contact information
Practice address
107 E CHERRY ST, WALLA WALLA, WA 99362-1912
(509) 525-7336
Mailing address
107 E CHERRY ST, WALLA WALLA, WA 99362-1912
(509) 525-7336
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DE60203055
WA
Other
Enumeration date
06/15/2016
Last updated
08/19/2020
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