MEDICARE: DR. ELIZABETH E COULTER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE00011194	WA

General Provider Information

NPI Number	:	1306024997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH E COULTER D.D.S.

Provider Business Mailing Address
First Line	:	1601 S DISHMAN MICA RD
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-3317
Country	:	US
Telephone Number	:	509-389-5650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 S DISHMAN MICA RD
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-3317
Country	:	US
Telephone Number	:	509-389-5650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	03/11/2024

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