Individual
DR. SCOTT SODERSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D D S P C
Contact information
Practice address
101 W CASCADE WAY, SUITE 200, SPOKANE, WA 99208-6003
(509) 467-5202
(509) 466-0518
Mailing address
101 W CASCADE WAY, SUITE 200, SPOKANE, WA 99208-6003
(509) 467-5202
(509) 468-0518
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00008668
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0150532
LABOR AND INDUSTRIES ID#
WA
01
—
1287SO
BLUE CROSS
—
01
—
174980063
ADA NUMBER
—
01
—
21933
UNITED CONCORDIA ID
WA
05
—
5037479
—
WA
01
—
602-040-560
UNIFIED BUSINESS ID
WA
01
—
91-2051287
TAX ID #
—
01
—
DE00008668
STATE DENTAL LICENSE
WA
Enumeration date
02/20/2006
Last updated
01/29/2024
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