# MC-LL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mint Condition Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871546184
- **Authorized official:** MR. MARSHALL F GIBBS DDS (OWNER)
- **Authorized official phone:** (509) 235-2900

## Contact information

- **Practice address:** 21801 E COUNTRY VISTA DR, STE 105, LIBERTY LAKE, WA 99019
- **Practice address phone:** (509) 926-5272
- **Practice address fax:** (509) 926-4855
- **Mailing address:** PO BOX 19187, SPOKANE, WA 99219
- **Mailing address phone:** (509) 926-5272
- **Mailing address fax:** (509) 926-4855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 10993 | WA | — |
| 1223G0001X | General Practice Dentistry | 8440 | WA | Yes |
| 1223G0001X | General Practice Dentistry | 8853 | WA | — |
| 1223G0001X | General Practice Dentistry | DE60240234 | WA | — |

## Other

- **Enumeration date:** 05/18/2006
- **Last updated:** 06/19/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5055470 | — | WA |