Organization
SPRINGFIELD KIDS DENTIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FEMINA JANE BEDOLLA (OPERATIONS OFFICER)
(541) 844-3113
Entity
Organization
Contact information
Practice address
5895 MAIN ST, SPRINGFIELD, OR 97478-6961
(541) 654-4996
(541) 505-8463
Mailing address
5895 MAIN ST, SPRINGFIELD, OR 97478-6961
(541) 654-4996
(541) 505-8463
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D8929
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528268281
PRIVATE INSURANCE
—
05
—
279295
—
OR
Enumeration date
11/26/2017
Last updated
11/26/2017
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