# ELLINGSEN HENNEBERG PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Smile Source Spokane, Smile Source North
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841845211
- **Authorized official:** DR. ERIC ELLINGSEN DDS (OWNER)
- **Authorized official phone:** (509) 924-2866

## Contact information

- **Practice address:** 6817 N CEDAR RD STE 201, SPOKANE, WA 99208-4277
- **Practice address phone:** (509) 326-8170
- **Mailing address:** 1215 N MCDONALD RD STE 203, SPOKANE VALLEY, WA 99216-1557
- **Mailing address phone:** (509) 924-2866

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 08/02/2019
- **Last updated:** 08/02/2019