| Liberty Lake Smile Source | |
|
22011 E Country Vista Dr Ste 201 Liberty Lake WA 99019-5242 | |
| (509) 927-9279 | |
| (509) 927-9278 |
| Full Name | Liberty Lake Smile Source |
|---|---|
| Speciality | Dentist |
| Location | 22011 E Country Vista Dr Ste 201, Liberty Lake, Washington |
| Authorized Official Name and Position | Lori A Christopherson (OFFICE MANAGER) |
| Authorized Official Contact | 5099279279 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberty Lake Smile Source 22011 E Country Vista Dr Ste 201 Liberty Lake WA 99019-5242 Ph: (509) 927-9279 | Liberty Lake Smile Source 22011 E Country Vista Dr Ste 201 Liberty Lake WA 99019-5242 Ph: (509) 927-9279 |
| NPI Number | 1568926046 |
|---|---|
| Provider Enumeration Date | 01/29/2019 |
| Last Update Date | 12/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568926046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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