Provider Demographics
NPI:1235904186
Name:BUILDING BLOCKS PEDIATRIC DENTISTRY, PC
Entity Type:Organization
Organization Name:BUILDING BLOCKS PEDIATRIC DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-363-1661
Mailing Address - Street 1:140 RAMSGATE SQ S STE 120
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5873
Mailing Address - Country:US
Mailing Address - Phone:503-363-1712
Mailing Address - Fax:
Practice Address - Street 1:140 RAMSGATE SQ S STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5872
Practice Address - Country:US
Practice Address - Phone:503-363-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty