Provider Demographics
NPI:1740479914
Name:LEWISTON-CLARKSTON ORAL & MAX. SURG. PC
Entity type:Organization
Organization Name:LEWISTON-CLARKSTON ORAL & MAX. SURG. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SATOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-751-1110
Mailing Address - Street 1:1119 HIGHLAND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2836
Mailing Address - Country:US
Mailing Address - Phone:509-751-1110
Mailing Address - Fax:509-751-1114
Practice Address - Street 1:1119 HIGHLAND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2836
Practice Address - Country:US
Practice Address - Phone:509-751-1110
Practice Address - Fax:509-751-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000077631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8804447OtherMEDICARE