Provider Demographics
NPI:1235521600
Name:RICHLAND DENTAL CENTER, PLLC
Entity Type:Organization
Organization Name:RICHLAND DENTAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-946-2258
Mailing Address - Street 1:1050 GILLMORE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3382
Mailing Address - Country:US
Mailing Address - Phone:509-946-2258
Mailing Address - Fax:509-946-1211
Practice Address - Street 1:1050 GILLMORE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3382
Practice Address - Country:US
Practice Address - Phone:509-946-2258
Practice Address - Fax:509-946-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA694123OtherUNITED CONCORDIA
WA5033246Medicaid