Provider Demographics
NPI:1992036271
Name:DENTAL CARE ASSOCIATES OF SPOKANE VALLEY
Entity Type:Organization
Organization Name:DENTAL CARE ASSOCIATES OF SPOKANE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-928-9100
Mailing Address - Street 1:507 N SULLIVAN RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8576
Mailing Address - Country:US
Mailing Address - Phone:509-928-9100
Mailing Address - Fax:509-924-3724
Practice Address - Street 1:507 N SULLIVAN RD
Practice Address - Street 2:SUITE A1
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8576
Practice Address - Country:US
Practice Address - Phone:509-928-9100
Practice Address - Fax:509-924-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5777602Medicaid