MEDICARE: DR. STANLEY A. SARGENT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5139	WA

General Provider Information

NPI Number	:	1053314856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY A. SARGENT D.D.S.

Provider Business Mailing Address
First Line	:	3707 S GRAND BLVD
Second Line	:	STE B
City	:	SPOKANE
State	:	WA
Zip	:	99203-2712
Country	:	US
Telephone Number	:	509-838-2434
Fax Number	:	509-623-1548

Provider Business Practice Location Address
First Line	:	3707 S GRAND BLVD
Second Line	:	STE B
City	:	SPOKANE
State	:	WA
Zip	:	99203-2712
Country	:	US
Telephone Number	:	509-838-2434
Fax Number	:	509-623-1548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/18/2011

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