Provider Demographics
NPI:1619915394
Name:PENTTILA SCHROEDER MAXFIELD,DDS, PS
Entity Type:Organization
Organization Name:PENTTILA SCHROEDER MAXFIELD,DDS, PS
Other - Org Name:WEST RICHLAND FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:FLETCHER
Authorized Official - Last Name:PENTTILA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-967-3421
Mailing Address - Street 1:4476 W VAN GIESEN ST
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-5411
Mailing Address - Country:US
Mailing Address - Phone:509-967-3421
Mailing Address - Fax:509-967-2186
Practice Address - Street 1:4476 W VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-5411
Practice Address - Country:US
Practice Address - Phone:509-967-3421
Practice Address - Fax:509-967-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty