Provider Demographics
NPI:1760461412
Name:TRANTOW, MICHAEL ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLAN
Last Name:TRANTOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 E BROADWAY AVE
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4972
Mailing Address - Country:US
Mailing Address - Phone:509-928-3363
Mailing Address - Fax:509-924-7680
Practice Address - Street 1:12121 E BROADWAY AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4972
Practice Address - Country:US
Practice Address - Phone:509-928-3363
Practice Address - Fax:509-924-7680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000054931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice