| River District Modern Dentistry Pllc | |
|
21808 E Indiana Ave Liberty Lake WA 99019-4004 | |
| (509) 408-5080 | |
| (509) 461-0403 |
| Full Name | River District Modern Dentistry Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 21808 E Indiana Ave, Liberty Lake, Washington |
| Authorized Official Name and Position | Mark Bradle (OWNER) |
| Authorized Official Contact | 5094085080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| River District Modern Dentistry Pllc 21808 E Indiana Ave Liberty Lake WA 99019-4004 Ph: (509) 408-5080 | River District Modern Dentistry Pllc 21808 E Indiana Ave Liberty Lake WA 99019-4004 Ph: (509) 408-5080 |
| NPI Number | 1215685599 |
|---|---|
| Provider Enumeration Date | 03/15/2022 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215685599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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