| Shadle Smile Source PLLC | |
|
4610 N Ash St Ste 2o1 Spokane WA 99205-1482 | |
| (509) 325-4313 | |
| Not Available |
| Full Name | Shadle Smile Source PLLC |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 4610 N Ash St Ste 2o1, Spokane, Washington |
| Authorized Official Name and Position | Timothy Casey (PRESIDENT) |
| Authorized Official Contact | 5092800002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shadle Smile Source PLLC 2513 N Chase Ln Liberty Lake WA 99019-7533 | Shadle Smile Source PLLC 4610 N Ash St Ste 2o1 Spokane WA 99205-1482 Ph: (509) 325-4313 |
| NPI Number | 1154083822 |
|---|---|
| Provider Enumeration Date | 10/11/2021 |
| Last Update Date | 10/11/2021 |
| Certification Date | 10/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154083822 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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