Provider Demographics
NPI:1053485524
Name:DAMOM & MAGNUSON ORTHODONTICS
Entity Type:Organization
Organization Name:DAMOM & MAGNUSON ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:506-924-9860
Mailing Address - Street 1:12406 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1051
Mailing Address - Country:US
Mailing Address - Phone:506-924-9860
Mailing Address - Fax:509-926-0818
Practice Address - Street 1:12406 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1051
Practice Address - Country:US
Practice Address - Phone:506-924-9860
Practice Address - Fax:509-926-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA76281223X0400X
WA77181223X0400X
WA34581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty