Provider Demographics
NPI:1740364561
Name:WEISHAAR, SUE ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:ELLEN
Last Name:WEISHAAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16212 E INDIANA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216
Mailing Address - Country:US
Mailing Address - Phone:509-922-3333
Mailing Address - Fax:509-922-6533
Practice Address - Street 1:1005 N EVERGREEN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1485
Practice Address - Country:US
Practice Address - Phone:509-922-3333
Practice Address - Fax:509-922-6533
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA374886OtherLABOR & INDUSTRIES