| Smile Source Spokane | |
|
1215 N Mcdonald Rd #203 Spokane Valley WA 99216-1557 | |
| (509) 924-2866 | |
| Not Available |
| Full Name | Smile Source Spokane |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1215 N Mcdonald Rd, Spokane Valley, Washington |
| Authorized Official Name and Position | Eric C Ellingsen (OWNER) |
| Authorized Official Contact | 5099242866 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Source Spokane 1215 N Mcdonald Rd #203 Spokane Valley WA 99216-1557 Ph: (509) 924-2866 | Smile Source Spokane 1215 N Mcdonald Rd #203 Spokane Valley WA 99216-1557 Ph: (509) 924-2866 |
| NPI Number | 1083169668 |
|---|---|
| Provider Enumeration Date | 08/24/2016 |
| Last Update Date | 08/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083169668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 601992748 (Washington) | Primary |
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