Healthcare Provider Details

I. General information

NPI: 1487756649
Provider Name (Legal Business Name): REX ALLEN MENKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13326 W 14TH STREET
AIRWAY HEIGHTS WA
99001
US

IV. Provider business mailing address

PO BOX 1570
AIRWAY HEIGHTS WA
99001
US

V. Phone/Fax

Practice location:
  • Phone: 509-244-3655
  • Fax: 509-244-9527
Mailing address:
  • Phone: 509-244-3655
  • Fax: 509-244-9527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: