Provider Demographics
NPI:1710437017
Name:INTEGRATED DENTAL ARTS, PLLC
Entity Type:Organization
Organization Name:INTEGRATED DENTAL ARTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:HAKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-464-3100
Mailing Address - Street 1:5011 W LOWELL AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8587
Mailing Address - Country:US
Mailing Address - Phone:509-464-3100
Mailing Address - Fax:
Practice Address - Street 1:5011 W LOWELL AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8587
Practice Address - Country:US
Practice Address - Phone:509-464-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 00006665122300000X
WADE 60575246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8809321Medicare Oscar/Certification