Provider Demographics
NPI:1033379169
Name:AES NORTH SPOKANE
Entity Type:Organization
Organization Name:AES NORTH SPOKANE
Other - Org Name:ACCESS ENDODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:FACER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-464-2620
Mailing Address - Street 1:PO BOX 48640
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-8640
Mailing Address - Country:US
Mailing Address - Phone:509-464-2620
Mailing Address - Fax:509-468-1069
Practice Address - Street 1:8404 N WALL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6171
Practice Address - Country:US
Practice Address - Phone:509-464-2620
Practice Address - Fax:509-468-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3855EN1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty