Healthcare Provider Details

I. General information

NPI: 1699119495
Provider Name (Legal Business Name): GEOFFREY T. PING D.D.S. AND ASIA DELA CRUZ D.D.S. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N. STRATFORD RD.
MOSES LAKE WA
98837
US

IV. Provider business mailing address

246 N. MISSION ST.
WENATCHEE WA
98801
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-2255
  • Fax:
Mailing address:
  • Phone: 509-664-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00010971
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number00010971
License Number StateWA

VIII. Authorized Official

Name: DR. GEOFFREY T PING
Title or Position: OWNER/PRESIDENT
Credential: D.D.S.
Phone: 509-664-5000