Provider Demographics
NPI:1821197989
Name:MICHAEL A TRANTOW DDS PS
Entity Type:Organization
Organization Name:MICHAEL A TRANTOW DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRANTOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-928-3363
Mailing Address - Street 1:12121 E BROADWAY
Mailing Address - Street 2:BLDG III
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99206
Mailing Address - Country:US
Mailing Address - Phone:509-928-3363
Mailing Address - Fax:509-924-7680
Practice Address - Street 1:12121 E BROADWAY
Practice Address - Street 2:BLDG III
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99206
Practice Address - Country:US
Practice Address - Phone:509-928-3363
Practice Address - Fax:509-924-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005493122300000X
WADH00001414124Q00000X
WADH00005591124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5561006Medicaid
WA5561006Medicaid