=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184975245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY K CONRAD DMD, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2012
-----------------------------------------------------
Last Update Date | 01/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W 2ND AVE
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99201-3655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-444-8200
-----------------------------------------------------
Fax | 509-835-1210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 N WASHINGTON ST STE 300
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99201-0254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-444-8888
-----------------------------------------------------
Fax | 509-444-7806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE60295294
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------