Organization
RIVER DISTRICT MODERN DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK BRADLE DMD (OWNER)
(509) 408-5080
Entity
Organization
Contact information
Practice address
21808 E INDIANA AVE, LIBERTY LAKE, WA 99019-4004
(509) 408-5080
(509) 461-0403
Mailing address
21808 E INDIANA AVE, LIBERTY LAKE, WA 99019-4004
(509) 408-5080
(509) 461-0403
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2022
Last updated
03/07/2023
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