Provider Demographics
NPI:1629524061
Name:SOUTH HILL PERIODONTICS
Entity Type:Organization
Organization Name:SOUTH HILL PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIARDINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-536-7032
Mailing Address - Street 1:2700 S SOUTHEAST BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4984
Mailing Address - Country:US
Mailing Address - Phone:509-536-7032
Mailing Address - Fax:509-536-7002
Practice Address - Street 1:2700 S SOUTHEAST BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4984
Practice Address - Country:US
Practice Address - Phone:509-536-7032
Practice Address - Fax:509-536-7002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHHILL PERIODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty