Provider Demographics
NPI:1376637793
Name:DAEHLIN, STEVEN REIDAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:REIDAR
Last Name:DAEHLIN
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 1:12805 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0795
Mailing Address - Country:US
Mailing Address - Phone:509-922-2353
Mailing Address - Fax:509-922-9014
Practice Address - Street 1:12805 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0795
Practice Address - Country:US
Practice Address - Phone:509-922-2353
Practice Address - Fax:509-922-9014
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA48401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice