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General NPI Number Information
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NPI Number | 1205593084
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Entity Type | Organization
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Legal Business Name | DOWN RIVER SMILES
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 3404 W NORTHWEST BLVD
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City | SPOKANE
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State | WA
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Zip | 99205-2144
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Country | US
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Telephone | 509-326-8039
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Fax |
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Provider Business Mailing Address
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Address Line | 2513 N CHASE LN
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-7533
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. TIM CASEY
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Credential | DDS
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Telephone | 509-280-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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