Provider Demographics
NPI:1720356330
Name:VICTOR V. CARNELL, DDS, PS
Entity Type:Organization
Organization Name:VICTOR V. CARNELL, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PS
Authorized Official - Phone:509-326-8120
Mailing Address - Street 1:4610 N ASH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1482
Mailing Address - Country:US
Mailing Address - Phone:509-326-8120
Mailing Address - Fax:
Practice Address - Street 1:4610 N ASH ST STE 204
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1482
Practice Address - Country:US
Practice Address - Phone:509-326-8120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty