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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