Provider Demographics
NPI:1053867150
Name:DAMON AND DAMON ORTHODONTICS
Entity Type:Organization
Organization Name:DAMON AND DAMON ORTHODONTICS
Other - Org Name:DAMON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PS
Authorized Official - Phone:509-484-8000
Mailing Address - Street 1:4407 N DIVISION ST STE 722
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1613
Mailing Address - Country:US
Mailing Address - Phone:509-484-8000
Mailing Address - Fax:
Practice Address - Street 1:4407 N DIVISION ST STE 722
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1613
Practice Address - Country:US
Practice Address - Phone:509-484-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAMON AND DAMON ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA66621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty