Healthcare Provider Details

I. General information

NPI: 1265642375
Provider Name (Legal Business Name): DAVID W ENGEN DDS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 N CEDAR RD STE 202
SPOKANE WA
99208-4277
US

IV. Provider business mailing address

6817 N CEDAR RD STE 202
SPOKANE WA
99208-4277
US

V. Phone/Fax

Practice location:
  • Phone: 509-326-4445
  • Fax: 509-326-4612
Mailing address:
  • Phone: 509-326-4445
  • Fax: 509-326-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9909
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8681
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7164
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8681
License Number StateWA

VIII. Authorized Official

Name: DR. DAVID W ENGEN
Title or Position: OWNER
Credential: DDS
Phone: 509-326-4445