Provider Demographics
NPI:1134534084
Name:SONBRIDGE COMMUNITY CENTER
Entity type:Organization
Organization Name:SONBRIDGE COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-301-3460
Mailing Address - Street 1:1200 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1827
Mailing Address - Country:US
Mailing Address - Phone:509-529-3100
Mailing Address - Fax:
Practice Address - Street 1:1200 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-1827
Practice Address - Country:US
Practice Address - Phone:509-529-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPPER COLUMBIA CONFERENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-29
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6033186701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty