Healthcare Provider Details

I. General information

NPI: 1548178585
Provider Name (Legal Business Name): MARISSA SHAELYN ZIGMUND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14319 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-2141
US

IV. Provider business mailing address

14319 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-2141
US

V. Phone/Fax

Practice location:
  • Phone: 509-998-4322
  • Fax:
Mailing address:
  • Phone: 509-998-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDENR.DN.70135987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: