MEDICARE: ABBIE E FARRELL DENTAL HYGIENE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH60173612	WA

General Provider Information

NPI Number	:	1194026674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBIE E FARRELL DENTAL HYGIENE

Provider Business Mailing Address
First Line	:	203 N WASHINGTON ST STE 300
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0233
Country	:	US
Telephone Number	:	509-444-8888
Fax Number	:	509-444-7806

Provider Business Practice Location Address
First Line	:	844 6TH ST
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2013
Country	:	US
Telephone Number	:	208-848-8308
Fax Number	:	509-444-7806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2010
Last Update Date	:	07/29/2016

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