Provider Demographics
NPI:1043394828
Name:THE KIDDS PLACE, DENTISTRY FOR CHILDREN, P.S.
Entity Type:Organization
Organization Name:THE KIDDS PLACE, DENTISTRY FOR CHILDREN, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:D
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-252-4746
Mailing Address - Street 1:506 E HASTINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1900
Mailing Address - Country:US
Mailing Address - Phone:509-252-4746
Mailing Address - Fax:509-789-1640
Practice Address - Street 1:506 E HASTINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1900
Practice Address - Country:US
Practice Address - Phone:509-252-4746
Practice Address - Fax:509-789-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000065251223G0001X
WADE000101911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5010848Medicaid
WA5010848Medicaid