Provider Demographics
NPI:1205852977
Name:DEFELICE, ARMAND V (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARMAND
Middle Name:V
Last Name:DEFELICE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5500
Mailing Address - Country:US
Mailing Address - Phone:509-327-7719
Mailing Address - Fax:509-327-7110
Practice Address - Street 1:4703 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-5500
Practice Address - Country:US
Practice Address - Phone:509-327-7719
Practice Address - Fax:509-327-7110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA29111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA19844OtherLABOR AND INDUSTRY
WA5060603Medicaid
WA839990OtherUNITED CONCORDIA PROVIDER
WA839990OtherUNITED CONCORDIA PROVIDER