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General NPI Number Information
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NPI Number | 1679733174
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Entity Type | Organization
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Legal Business Name | COUNTRY RIDGE FAMILY DENTAL PLLC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 7233 W DESCHUTES AVE SUITE E
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City | KENNEWICK
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State | WA
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Zip | 99336-6707
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Country | US
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Telephone | 509-374-4077
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Fax | 509-374-2737
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Provider Business Mailing Address
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Address Line | 7233 W DESCHUTES AVE SUITE E
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City | KENNEWICK
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State | WA
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Zip | 99336
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Country | US
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Telephone | 509-374-4077
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Fax | 509-374-2737
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CRAIG KENT BARNEY
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Credential | DMD
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Telephone | 509-374-4077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE00010238
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License Number State | WA
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