Provider Demographics
NPI:1578782231
Name:NORTHWEST DENTURE STUDIO OF SPOKANE
Entity Type:Organization
Organization Name:NORTHWEST DENTURE STUDIO OF SPOKANE
Other - Org Name:JEFFREY W EISNER SR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WHITMAN
Authorized Official - Last Name:EISNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPD DENTURIST
Authorized Official - Phone:509-328-2117
Mailing Address - Street 1:121 W CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-5185
Mailing Address - Country:US
Mailing Address - Phone:509-276-2722
Mailing Address - Fax:509-276-8145
Practice Address - Street 1:121 W CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-5185
Practice Address - Country:US
Practice Address - Phone:509-276-2722
Practice Address - Fax:509-276-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000034122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Multi-Specialty