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General NPI Number Information
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NPI Number | 1467392233
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Entity Type | Organization
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Legal Business Name | AVANTA DENTAL LIBERTY LAKE
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 21808 E INDIANA AVE
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-4004
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Country | US
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Telephone | 509-425-0088
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Fax | 509-416-2030
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Provider Business Mailing Address
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Address Line | 21808 E INDIANA AVE
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-4004
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Country | US
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Telephone | 509-425-0088
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Fax | 509-416-2030
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Authorized Official
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Title or Position | CREDENTIALING
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Name | SARAH A COMPOGNO
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Credential | RDA
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Telephone | 509-425-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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