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General NPI Number Information
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NPI Number | 1164462487
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Entity Type | Organization
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Legal Business Name | MC-NSPK LLC
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 5901 N. LIDGERWOOD STE 233
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City | SPOKANE
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State | WA
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Zip | 99208
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Country | US
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Telephone | 509-489-4763
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Fax | 509-489-4767
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Provider Business Mailing Address
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Address Line | PO BOX 19187
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City | SPOKANE
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State | WA
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Zip | 99219-9187
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Country | US
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Telephone | 509-489-4763
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Fax | 509-489-4767
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARSHALL F GIBBS
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Credential | DDS
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Telephone | 509-235-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60240234
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8853
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8440
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License Number State | WA
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