Provider Demographics
NPI:1821316340
Name:DAMON, PAUL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:DAMON
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 1:12406 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1051
Mailing Address - Country:US
Mailing Address - Phone:509-924-9860
Mailing Address - Fax:509-926-0818
Practice Address - Street 1:12406 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1051
Practice Address - Country:US
Practice Address - Phone:509-924-9860
Practice Address - Fax:509-926-0818
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA77181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053485524OtherNPI FOR ORGANIZATION