Provider Demographics
NPI:1700065794
Name:LAYNE D HINCKLEY DDS PS
Entity Type:Organization
Organization Name:LAYNE D HINCKLEY DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HINCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-926-6261
Mailing Address - Street 1:12121 E BROADWAY AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4972
Mailing Address - Country:US
Mailing Address - Phone:509-626-6261
Mailing Address - Fax:509-926-6262
Practice Address - Street 1:12121 E BROADWAY AVE STE 4
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4972
Practice Address - Country:US
Practice Address - Phone:509-626-6261
Practice Address - Fax:509-926-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6479860001Medicare NSC