# SHADLE SMILE SOURCE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154083822
- **Authorized official:** DR. TIMOTHY CASEY DDS (PRESIDENT)
- **Authorized official phone:** (509) 280-0002

## Contact information

- **Practice address:** 4610 N ASH ST STE 2O1, SPOKANE, WA 99205-1482
- **Practice address phone:** (509) 325-4313
- **Mailing address:** 2513 N CHASE LN, LIBERTY LAKE, WA 99019-7533

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/11/2021
- **Last updated:** 10/11/2021