Provider Demographics
NPI:1942710231
Name:FREUEN HAUCK PAXTON OMS PLLC
Entity Type:Organization
Organization Name:FREUEN HAUCK PAXTON OMS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:KRISTEN
Authorized Official - Last Name:BANCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-242-3336
Mailing Address - Street 1:9911 N NEVADA ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1298
Mailing Address - Country:US
Mailing Address - Phone:509-242-3336
Mailing Address - Fax:866-554-1392
Practice Address - Street 1:9911 N NEVADA ST STE 120
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1298
Practice Address - Country:US
Practice Address - Phone:509-242-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223S0112X
1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60378265OtherWASHINGTON STATE LICENSE
WA8645OtherWASHINGTON STATE LICENSE