| Smile Source Spokane | |
|
2607 S Southeast Blvd Ste B210 Spokane WA 99223-7614 | |
| (509) 924-2866 | |
| Not Available |
| Full Name | Smile Source Spokane |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2607 S Southeast Blvd Ste B210, Spokane, 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 Ste 203 Spokane Valley WA 99216-1557 Ph: (509) 924-2866 | Smile Source Spokane 2607 S Southeast Blvd Ste B210 Spokane WA 99223-7614 Ph: (509) 924-2866 |
| NPI Number | 1215535695 |
|---|---|
| Provider Enumeration Date | 10/16/2020 |
| Last Update Date | 10/21/2020 |
| Certification Date | 10/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215535695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (NU) | Primary |
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