Provider Demographics
NPI:1356884530
Name:PEDIATRIC DENTISTRY OF PLEASANT HILL
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY OF PLEASANT HILL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER EQUAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMYBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-947-1188
Mailing Address - Street 1:2710 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2036
Mailing Address - Country:US
Mailing Address - Phone:925-947-1188
Mailing Address - Fax:925-947-0252
Practice Address - Street 1:2710 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2036
Practice Address - Country:US
Practice Address - Phone:925-947-1188
Practice Address - Fax:925-947-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215821223P0221X
CA446891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty