Provider Demographics
NPI:1508083627
Name:SPOKANE DIGITAL DIAGNOSTIC
Entity Type:Organization
Organization Name:SPOKANE DIGITAL DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-926-7106
Mailing Address - Street 1:12109 E BROADWAY AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6133
Mailing Address - Country:US
Mailing Address - Phone:509-926-7106
Mailing Address - Fax:
Practice Address - Street 1:12109 E BROADWAY AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6133
Practice Address - Country:US
Practice Address - Phone:509-926-7106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery