ELLINGSEN HENNEBERG PLLC NPI 1215535695

NPI Information

ELLINGSEN HENNEBERG PLLC is a dental clinic center in Spokane, WA. ELLINGSEN HENNEBERG PLLC NPI is 1215535695. The provider is registered as an organization entity type.
The provider Is Doing Business As Smile Source Spokane.

The provider's business location address is:

2607 S SOUTHEAST BLVD STE B210
SPOKANE, WA
ZIP 99223-614
Phone: (509) 924-2866

The provider's authorized official is Eric C Ellingsen .
The authorized official title is Owner and has the following contact phone number (509) 924-2866.

The enumeration date for this NPI number is 10/16/2020 and was last updated on 10/21/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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