# EVOLUTION DENTAL ALLIANCE

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

## Provider details

- **NPI number:** 1689175309
- **Authorized official:** DR. JOEL BLAKE DMD (CHIEF CLINICAL OFFICER)
- **Authorized official phone:** (509) 822-2209

## Contact information

- **Practice address:** 507 S WASHINGTON ST STE 190, SPOKANE, WA 99204-2608
- **Practice address phone:** (509) 566-0000
- **Mailing address:** 507 S WASHINGTON ST STE 40, SPOKANE, WA 99204-2604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/27/2018
- **Last updated:** 02/27/2018