Organization
SHADLE SMILE SOURCE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY CASEY DDS (PRESIDENT)
(509) 280-0002
Entity
Organization
Contact information
Practice address
4610 N ASH ST STE 2O1, SPOKANE, WA 99205-1482
(509) 325-4313
Mailing address
2513 N CHASE LN, LIBERTY LAKE, WA 99019-7533
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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