Organization
FREUEN HAUCK PAXTON OMS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE KRISTEN BANCROFT (ADMIN MANAGER)
(509) 242-3336
Entity
Organization
Contact information
Practice address
9911 N NEVADA ST STE 120, SPOKANE, WA 99218-1298
(509) 242-3336
Mailing address
9911 N NEVADA ST STE 120, SPOKANE, WA 99218-1298
(509) 242-3336
(866) 554-1392
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
WA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60378265
WASHINGTON STATE LICENSE
WA
01
—
8645
WASHINGTON STATE LICENSE
WA
Enumeration date
10/02/2017
Last updated
04/04/2019
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