Provider Demographics
NPI:1376097691
Name:GEORGE J. BOUREKIS, D.D.S., P.S.
Entity Type:Organization
Organization Name:GEORGE J. BOUREKIS, D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOUREKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-922-2288
Mailing Address - Street 1:12525 E MISSION AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1079
Mailing Address - Country:US
Mailing Address - Phone:509-922-2288
Mailing Address - Fax:509-863-9527
Practice Address - Street 1:12525 E MISSION AVE
Practice Address - Street 2:STE 204
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1079
Practice Address - Country:US
Practice Address - Phone:509-922-2288
Practice Address - Fax:509-863-9527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000070591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1020375Medicaid