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General NPI Number Information
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NPI Number | 1336545938
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Entity Type | Organization
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Legal Business Name | CENTRAL SPOKANE DENTAL, LLC
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Dates
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Enumeration Date | 11/08/2014
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Last Update Date | 11/08/2014
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Provider Practice Location Address
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Address Line | 6411 N DIVISION ST
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City | SPOKANE
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State | WA
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Zip | 99208-3935
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Country | US
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Telephone | 509-465-1561
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Fax |
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Provider Business Mailing Address
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Address Line | 6411 N DIVISION ST
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City | SPOKANE
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State | WA
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Zip | 99208-3935
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Country | US
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Telephone | 509-465-1561
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | PATRICK HUDSON
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Credential | DDS
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Telephone | 719-661-6639
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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 | DE60028811
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License Number State | WA
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