Provider Demographics
NPI:1720255102
Name:COMBS, STEPHANIE CLARK (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CLARK
Last Name:COMBS
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:418 E 30TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2581
Mailing Address - Country:US
Mailing Address - Phone:509-624-1139
Mailing Address - Fax:509-624-4617
Practice Address - Street 1:418 E 30TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2581
Practice Address - Country:US
Practice Address - Phone:509-624-1139
Practice Address - Fax:509-624-4617
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA87161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics