Provider Demographics
NPI:1982790630
Name:C ROSS SIMONDS DDS PS
Entity Type:Organization
Organization Name:C ROSS SIMONDS DDS PS
Other - Org Name:LIBERTY LAKE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:SIMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-893-1119
Mailing Address - Street 1:23403 E MISSION AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7553
Mailing Address - Country:US
Mailing Address - Phone:509-893-1119
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-7553
Practice Address - Country:US
Practice Address - Phone:509-893-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000084431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty