| Scott Soderstrom D D S P C | |
|
101 W Cascade Way Ste 200 Spokane WA 99208-6000 | |
| (509) 467-5202 | |
| (509) 466-0518 |
| Full Name | Scott Soderstrom D D S P C |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 W Cascade Way Ste 200, Spokane, Washington |
| Authorized Official Name and Position | Tracy Johnson (PATIENT ACCOUNTS AND BILLING) |
| Authorized Official Contact | 5094675202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scott Soderstrom D D S P C 101 W Cascade Way Ste 200 Spokane WA 99208-6000 Ph: (509) 467-5202 | Scott Soderstrom D D S P C 101 W Cascade Way Ste 200 Spokane WA 99208-6000 Ph: (509) 467-5202 |
| NPI Number | 1316460421 |
|---|---|
| Provider Enumeration Date | 07/20/2017 |
| Last Update Date | 03/06/2023 |
| Medicare PECOS PAC ID | 6103155783 |
|---|---|
| Medicare Enrollment ID | O20190906001679 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316460421 | NPI | - | NPPES |
| 5034749 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Scott Soderstrom |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1457326878 PECOS PAC ID: 6709199466 Enrollment ID: I20190917002245 |
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