Healthcare Provider Details

I. General information

NPI: 1235512229
Provider Name (Legal Business Name): KEVIN K SANDERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N ARGONNE RD
SPOKANE VALLEY WA
99212-2794
US

IV. Provider business mailing address

720 N ARGONNE RD
SPOKANE VALLEY WA
99212-2794
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-7500
  • Fax: 509-928-0904
Mailing address:
  • Phone: 509-928-7500
  • Fax: 509-928-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE60561209
License Number StateWA

VIII. Authorized Official

Name: DR. KEVIN K SANDERS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 509-928-7500