Healthcare Provider Details

I. General information

NPI: 1407281587
Provider Name (Legal Business Name): PAULA J WASHINGTON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 43RD ST
PHILADELPHIA PA
19104-4408
US

IV. Provider business mailing address

119 W BALTIMORE AVE APT 4C
LANSDOWNE PA
19050-1859
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-7506
  • Fax:
Mailing address:
  • Phone: 267-250-5385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH068616
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: