Provider Demographics
NPI:1861826489
Name:MOSES LAKE PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:MOSES LAKE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:PING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-664-5000
Mailing Address - Street 1:800 N STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1512
Mailing Address - Country:US
Mailing Address - Phone:509-765-2255
Mailing Address - Fax:
Practice Address - Street 1:800 N STRATFORD RD
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1512
Practice Address - Country:US
Practice Address - Phone:509-765-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WENATCHEE PEDATRIC DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000109711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty