Healthcare Provider Details

I. General information

NPI: 1942399324
Provider Name (Legal Business Name): TOILLION PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 N NEVADA ST
SPOKANE WA
99218-3412
US

IV. Provider business mailing address

9711 N NEVADA ST
SPOKANE WA
99218-3412
US

V. Phone/Fax

Practice location:
  • Phone: 509-755-5437
  • Fax: 509-755-0444
Mailing address:
  • Phone: 509-755-5437
  • Fax: 509-755-0444

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: 509-755-5437