Organization
LAKEVIEW DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SPENCER WIRIG DMD (OWNER)
(208) 664-0884
Entity
Organization
Contact information
Practice address
801 W MILWAUKEE DR, COEUR D ALENE, ID 83814-2236
(208) 664-0884
(208) 664-3304
Mailing address
801 W MILWAUKEE DR, COEUR D'ALENE, ID 83814
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4020
ID
332BC3200X
Customized Equipment (DME)
D4020
ID
Other
Enumeration date
04/26/2016
Last updated
04/26/2016
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