Provider Demographics
NPI:1265642375
Name:DAVID W ENGEN DDS PS
Entity Type:Organization
Organization Name:DAVID W ENGEN DDS PS
Other - Org Name:DARWIN W ENGEN DDS PS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-326-4445
Mailing Address - Street 1:6817 N CEDAR RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4277
Mailing Address - Country:US
Mailing Address - Phone:509-326-4445
Mailing Address - Fax:509-326-4612
Practice Address - Street 1:6817 N CEDAR RD STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4277
Practice Address - Country:US
Practice Address - Phone:509-326-4445
Practice Address - Fax:509-326-4612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DARWIN W ENGEN DDS PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7164122300000X
WA86811223P0300X, 1223X0400X
WA99091223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA67016OtherLABOR & INDUSTRIES
WA5046651Medicaid