Healthcare Provider Details

I. General information

NPI: 1942710231
Provider Name (Legal Business Name): FREUEN HAUCK PAXTON OMS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 N NEVADA ST STE 120
SPOKANE WA
99218-1298
US

IV. Provider business mailing address

9911 N NEVADA ST STE 120
SPOKANE WA
99218-1298
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateWA

VIII. Authorized Official

Name: MRS. RENEE KRISTEN BANCROFT
Title or Position: ADMIN MANAGER
Credential:
Phone: 509-242-3336