Provider Demographics
NPI:1710380886
Name:BITTNER DENTISTRY FOR KIDS
Entity Type:Organization
Organization Name:BITTNER DENTISTRY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRINITY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GEMMILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-625-5437
Mailing Address - Street 1:17680 SW HANDLEY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9255
Mailing Address - Country:US
Mailing Address - Phone:503-625-5437
Mailing Address - Fax:503-625-5433
Practice Address - Street 1:17680 SW HANDLEY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9255
Practice Address - Country:US
Practice Address - Phone:503-625-5437
Practice Address - Fax:503-625-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89001223P0221X
ORD99751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty