Healthcare Provider Details

I. General information

NPI: 1326121443
Provider Name (Legal Business Name): TOILLION PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 E 30TH AVE
SPOKANE WA
99203-2556
US

IV. Provider business mailing address

418 E 30TH AVE
SPOKANE WA
99203-2556
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-1182
  • Fax: 509-624-0823
Mailing address:
  • Phone: 509-624-1182
  • Fax: 509-624-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4735
License Number StateWA

VIII. Authorized Official

Name: DR. BRUCE C TOILLION
Title or Position: OWNER
Credential: DDS
Phone: 509-624-1182