Healthcare Provider Details

I. General information

NPI: 1558854844
Provider Name (Legal Business Name): HINTZ, OLARU, & PENBERTHY, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 W 7TH AVE STE 202
SPOKANE WA
99204-2850
US

IV. Provider business mailing address

823 W 7TH AVE STE 202
SPOKANE WA
99204-2850
US

V. Phone/Fax

Practice location:
  • Phone: 509-744-0916
  • Fax: 509-744-0961
Mailing address:
  • Phone: 509-744-0916
  • Fax: 509-744-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE00006981
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDE60739845
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60733503
License Number StateWA

VIII. Authorized Official

Name: DELILAH LESSOR
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-744-0916