Basic Information
| Provider Information | |||||||||
| NPI: | 1245527100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETRIE | ||||||||
| FirstName: | ARVIND | ||||||||
| MiddleName: | JEFFREY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3722 S VIRGINIA LN | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992068414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063516940 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 82 E FRANCIS AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992081070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094844746 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2011 | ||||||||
| LastUpdateDate: | 06/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DE60233848 | WA | Y | Dental Providers | Dentist | General Practice |
No ID Information.