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NPI Code Detail

MEDICARE: PENTTILA SCHROEDER MAXFIELD,DDS, PS

MEDICARE: PENTTILA SCHROEDER MAXFIELD,DDS, PS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1619915394
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENTTILA SCHROEDER MAXFIELD,DDS, PS
Provider Business Mailing Address
First Line : 4476 W VAN GIESEN ST
Second Line :
City : WEST RICHLAND
State : WA
Zip : 99353-5411
Country : US
Telephone Number : 509-967-3421
Fax Number : 509-967-2186
Provider Business Practice Location Address
First Line : 4476 W VAN GIESEN ST
Second Line :
City : WEST RICHLAND
State : WA
Zip : 99353-5411
Country : US
Telephone Number : 509-967-3421
Fax Number : 509-967-2186
Authorized Official
Title or Position : MANAGER/OWNER
Name : MR. WAYNE FLETCHER PENTTILA
Credential : DDS
Telephone Number : 509-967-3421
Provider Enumeration Date : 06/03/2006
Last Update Date : 08/23/2007

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