# ELLINGSEN HENNEBERG PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ELLINGSEN HENNEBERG PLLC
- **Other names:** Smile Source Spokane
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1215535695
- **Legal business name:** ELLINGSEN HENNEBERG PLLC
- **Authorized official:** ERIC C ELLINGSEN DDS (OWNER)
- **Authorized official phone:** (509) 924-2866

## Contact information

- **Practice address:** 2607 S SOUTHEAST BLVD STE B210, SPOKANE, WA 99223-7614
- **Practice address phone:** (509) 924-2866
- **Mailing address:** 1215 N MCDONALD RD STE 203, SPOKANE VALLEY, WA 99216-1557
- **Mailing address phone:** (509) 924-2866
- **Mailing address fax:** (509) 924-8311

## Taxonomy

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

## Other

- **Enumeration date:** 10/16/2020
- **Last updated:** 10/21/2020