Provider Demographics
NPI:1316496482
Name:SPOKANE ENDODONTICS PS
Entity type:Organization
Organization Name:SPOKANE ENDODONTICS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-928-8762
Mailing Address - Street 1:620 N ARGONNE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2792
Mailing Address - Country:US
Mailing Address - Phone:509-928-8762
Mailing Address - Fax:509-928-0110
Practice Address - Street 1:620 N ARGONNE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2792
Practice Address - Country:US
Practice Address - Phone:509-928-8762
Practice Address - Fax:509-928-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007422261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental