Provider Demographics
NPI:1942518154
Name:SOUTH HILL PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:SOUTH HILL PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:616-485-6911
Mailing Address - Street 1:2403 S CORBIN CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-7749
Mailing Address - Country:US
Mailing Address - Phone:616-485-6911
Mailing Address - Fax:
Practice Address - Street 1:2020 E 29TH AVENUE
Practice Address - Street 2:130
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203
Practice Address - Country:US
Practice Address - Phone:616-485-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600580991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty