Individual
ETHAN LEE BROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3919 N MAPLE ST, SPOKANE, WA 99205-1349
(509) 444-8200
Mailing address
611 N IRON BRIDGE WAY, SPOKANE, WA 99202-4932
(509) 444-8888
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE61103491
WA
Other
Enumeration date
08/22/2019
Last updated
11/02/2022
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