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General NPI Number Information
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NPI Number | 1346117629
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Entity Type | Organization
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Legal Business Name | MC-GA, LLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 1612 N BARKER RD # 0
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City | SPOKANE VALLEY
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State | WA
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Zip | 99016-5036
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Country | US
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Telephone | 509-922-2211
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Fax |
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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 | 509-922-2211
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MARSHALL GIBBS
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Credential | DDS
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Telephone | 208-790-3253
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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 |
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License Number State |
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