Healthcare Provider Details

I. General information

NPI: 1639789787
Provider Name (Legal Business Name): CATRICE OPICHKA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 HILTY LN
BOW WA
98232-9544
US

IV. Provider business mailing address

PO BOX 325
BOW WA
98232-0325
US

V. Phone/Fax

Practice location:
  • Phone: 360-464-1177
  • Fax:
Mailing address:
  • Phone: 360-464-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.60424538
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: