Healthcare Provider Details

I. General information

NPI: 1659596948
Provider Name (Legal Business Name): DAVID WAYNE ENGEN DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9911 N NEVADA ST STE 110
SPOKANE WA
99218
US

IV. Provider business mailing address

9911 N NEVADA ST STE 110
SPOKANE WA
99218-1298
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 Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8681
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8681
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: