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General NPI Number Information
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NPI Number | 1740690247
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Entity Type | Organization
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Legal Business Name | LATAH CREEK FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 4001 S CHENEY-SPOKANE RD SUITE B
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City | SPOKANE
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State | WA
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Zip | 99224
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Country | US
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Telephone | 509-455-5001
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Fax | 509-891-2787
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Provider Business Mailing Address
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Address Line | 1328 N STANFORD LN SUITE 100
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-5034
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Country | US
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Telephone | 509-891-5001
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Fax | 509-891-2787
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | MICHELLE RENEE OLMSTEAD
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Credential | DDS
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Telephone | 509-891-5001
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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 | DE00008465
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License Number State | WA
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