Organization
COLUMBIA BASIN PEDICATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY W LOVERIDGE (OWNER)
(509) 783-1960
Entity
Organization
Contact information
Practice address
7501 W DESCHUTES PL, KENNEWICK, WA 99336-7719
(509) 783-1960
Mailing address
7501 W DESCHUTES PL, KENNEWICK, WA 99336-7719
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DE00007618
WA
1223P0221X
Pediatric Dentistry
DE00008974
WA
1223P0221X
Pediatric Dentistry
DE00009527
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5036876
—
WA
01
—
AB32234
SURGICAL CENTER
WA
Enumeration date
10/17/2006
Last updated
08/22/2020
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