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General NPI Number Information
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NPI Number | 1710380886
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Entity Type | Organization
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Legal Business Name | BITTNER DENTISTRY FOR KIDS
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 17680 SW HANDLEY ST SUITE 201
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City | SHERWOOD
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State | OR
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Zip | 97140-9255
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Country | US
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Telephone | 503-625-5437
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Fax | 503-625-5433
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Provider Business Mailing Address
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Address Line | 17680 SW HANDLEY ST SUITE 201
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City | SHERWOOD
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State | OR
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Zip | 97140-9255
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Country | US
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Telephone | 503-625-5437
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Fax | 503-625-5433
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TRINITY E GEMMILL
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Credential |
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Telephone | 503-625-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D9975
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D8900
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License Number State | OR
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