Provider Demographics
NPI:1366640633
Name:GERIATRIC FAMILY CARE, PS
Entity Type:Organization
Organization Name:GERIATRIC FAMILY CARE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:DENTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-465-9776
Mailing Address - Street 1:1010 W ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4257
Mailing Address - Country:US
Mailing Address - Phone:509-465-9776
Mailing Address - Fax:509-465-9058
Practice Address - Street 1:1010 W ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4257
Practice Address - Country:US
Practice Address - Phone:509-465-9776
Practice Address - Fax:509-465-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000141207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7083884Medicaid