Healthcare Provider Details

I. General information

NPI: 1932228236
Provider Name (Legal Business Name): MICHAEL P CONDON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 N MOLTER RD
LIBERTY LAKE WA
99019-7570
US

IV. Provider business mailing address

2207 N MOLTER RD
LIBERTY LAKE WA
99019-7570
US

V. Phone/Fax

Practice location:
  • Phone: 509-926-5272
  • Fax: 509-926-4855
Mailing address:
  • Phone: 509-926-5272
  • Fax: 509-926-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: