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General NPI Number Information
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NPI Number | 1740479914
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Entity Type | Organization
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Legal Business Name | LEWISTON-CLARKSTON ORAL & MAX. SURG. PC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 1119 HIGHLAND AVE SUITE 6
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City | CLARKSTON
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State | WA
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Zip | 99403-2836
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Country | US
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Telephone | 509-751-1110
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Fax | 509-751-1114
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Provider Business Mailing Address
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Address Line | 1119 HIGHLAND AVE SUITE 6
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City | CLARKSTON
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State | WA
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Zip | 99403-2836
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Country | US
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Telephone | 509-751-1110
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Fax | 509-751-1114
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Authorized Official
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Title or Position | OWNER/ORAL SURGEON
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Name | SARAH SATOW
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Credential |
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Telephone | 509-751-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE00007763
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License Number State | WA
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