| Childrens Dental Village | |
|
420 N Evergreen Rd Suite 200 Spokane Valley WA 99216-0973 | |
| (509) 891-9011 | |
| (509) 891-8999 |
| Full Name | Childrens Dental Village |
|---|---|
| Speciality | Dentist |
| Location | 420 N Evergreen Rd, Spokane Valley, Washington |
| Authorized Official Name and Position | Teri R Jackson (BUSINESS MANAGER) |
| Authorized Official Contact | 5098919011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Childrens Dental Village 420 N Evergreen Rd Suite 200 Spokane Valley WA 99216-0973 Ph: (509) 891-9011 | Childrens Dental Village 420 N Evergreen Rd Suite 200 Spokane Valley WA 99216-0973 Ph: (509) 891-9011 |
| NPI Number | 1710117304 |
|---|---|
| Provider Enumeration Date | 07/17/2009 |
| Last Update Date | 04/28/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710117304 | NPI | - | NPPES |
| 2001636 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DE00010409 (Washington) | Primary |
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