Provider Demographics
NPI:1417237512
Name:WILSON, ALLEN AND ASSOCIATES
Entity Type:Organization
Organization Name:WILSON, ALLEN AND ASSOCIATES
Other - Org Name:SLEEP DENTISTRY OF SPOKANE, ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-536-5900
Mailing Address - Street 1:3143 E 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4815
Mailing Address - Country:US
Mailing Address - Phone:509-536-5900
Mailing Address - Fax:509-534-1015
Practice Address - Street 1:3143 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4815
Practice Address - Country:US
Practice Address - Phone:509-536-5900
Practice Address - Fax:509-534-1015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON, ALLEN AND ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-19
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-112-613261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50-C0001261OtherMEDICARE NUMBER
WA7134356Medicaid