Healthcare Provider Details

I. General information

NPI: 1811070501
Provider Name (Legal Business Name): JOSEPH JOHN PAWLUSIAK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 N MAPLE ST
SPOKANE WA
99205
US

IV. Provider business mailing address

203 N WASHINGTON ST STE 300
SPOKANE WA
99201-0254
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8888
  • Fax: 509-444-7806
Mailing address:
  • Phone: 509-444-8888
  • Fax: 509-444-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7018
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE00007018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: