Organization
MC-NSPK LLC
Active
Other names
Mint Condition Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARSHALL F GIBBS DDS (OWNER)
(509) 235-2900
Entity
Organization
Contact information
Practice address
5901 N. LIDGERWOOD, STE 233, SPOKANE, WA 99208
(509) 489-4763
(509) 489-4767
Mailing address
PO BOX 19187, SPOKANE, WA 99219-9187
(509) 489-4763
(509) 489-4767
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
60240234
WA
1223G0001X
General Practice Dentistry
Primary
8440
WA
1223G0001X
General Practice Dentistry
8853
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5031968
—
WA
Enumeration date
06/07/2006
Last updated
06/28/2018
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