Provider Demographics
NPI:1083160824
Name:SPOKANE VALLEY DENTAL
Entity Type:Organization
Organization Name:SPOKANE VALLEY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-928-8431
Mailing Address - Street 1:200 N MULLAN RD. #103
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-928-8431
Mailing Address - Fax:509-928-3522
Practice Address - Street 1:200 N MULLAN RD STE 103
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6800
Practice Address - Country:US
Practice Address - Phone:509-928-8431
Practice Address - Fax:509-928-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA91571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty