# SPOKANE OMS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Spokane Oral & Maxillofacial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497789820
- **Authorized official:** MRS. MARLA A TELIN (COO)
- **Authorized official phone:** (509) 926-7106

## Contact information

- **Practice address:** 12109 E BROADWAY AVENUE SUITE C, SPOKANE VALLEY, WA 99206-6133
- **Practice address phone:** (509) 926-7106
- **Practice address fax:** (509) 926-2833
- **Mailing address:** 12109 E BROADWAY AVE STE C, SPOKANE VALLEY, WA 99206-6133
- **Mailing address phone:** (509) 926-7106
- **Mailing address fax:** (509) 926-2833

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | WA | Yes |

## Other

- **Enumeration date:** 07/10/2006
- **Last updated:** 07/21/2022