Provider Demographics
NPI:1235895160
Name:PERIO DOCS - LEWISTON PLLC
Entity Type:Organization
Organization Name:PERIO DOCS - LEWISTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-326-4445
Mailing Address - Street 1:9911 N NEVADA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1298
Mailing Address - Country:US
Mailing Address - Phone:509-326-4445
Mailing Address - Fax:
Practice Address - Street 1:3323 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4423
Practice Address - Country:US
Practice Address - Phone:208-743-1114
Practice Address - Fax:208-743-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental