Provider Demographics
NPI:1972712966
Name:PING, GEOFFREY TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:TYLER
Last Name:PING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SUNTIDES BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9025
Mailing Address - Country:US
Mailing Address - Phone:206-999-6144
Mailing Address - Fax:
Practice Address - Street 1:2205 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2437
Practice Address - Country:US
Practice Address - Phone:509-575-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR200001511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry