Provider Demographics
NPI:1588017636
Name:H KIRBY SKAVDAHL DDS PS
Entity Type:Organization
Organization Name:H KIRBY SKAVDAHL DDS PS
Other - Org Name:TRI-CITIES PERIODONTICS & IMPLANTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:KIRBY
Authorized Official - Last Name:SKAVDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-783-5722
Mailing Address - Street 1:7409 W GRANDRIDGE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6710
Mailing Address - Country:US
Mailing Address - Phone:509-783-5722
Mailing Address - Fax:509-735-2822
Practice Address - Street 1:7409 W GRANDRIDGE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6710
Practice Address - Country:US
Practice Address - Phone:509-783-5722
Practice Address - Fax:509-735-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5324261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245368604OtherINDIVIDUAL NPI #