Healthcare Provider Details

I. General information

NPI: 1649642638
Provider Name (Legal Business Name): NORTHWEST IMPLANTS AND SLEEP DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 N. NEVADA AVE SUITE 120
SPOKANE WA
99218-2500
US

IV. Provider business mailing address

9911 N. NEVADA AVE SUITE 120
SPOKANE WA
99218-2500
US

V. Phone/Fax

Practice location:
  • Phone: 509-242-3336
  • Fax: 866-554-1392
Mailing address:
  • Phone: 509-242-3336
  • Fax: 866-554-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK CHRISTOPHER PAXTON
Title or Position: OWNER
Credential: DDS
Phone: 509-242-3336