Provider Demographics
NPI:1558854844
Name:HINTZ, OLARU, & PENBERTHY, DDS, PLLC
Entity Type:Organization
Organization Name:HINTZ, OLARU, & PENBERTHY, DDS, PLLC
Other - Org Name:MARYCLIFF DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-744-0916
Mailing Address - Street 1:823 W 7TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2850
Mailing Address - Country:US
Mailing Address - Phone:509-744-0916
Mailing Address - Fax:509-744-0961
Practice Address - Street 1:823 W 7TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2850
Practice Address - Country:US
Practice Address - Phone:509-744-0916
Practice Address - Fax:509-744-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60733503122300000X, 122300000X
WADE000069811223E0200X
WADE607398451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty