Healthcare Provider Details

I. General information

NPI: 1922436351
Provider Name (Legal Business Name): ANDREA JANINE KAUFFMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10729 189TH AVE NE
GRANITE FALLS WA
98252-8482
US

IV. Provider business mailing address

10729 189TH AVE NE
GRANITE FALLS WA
98252-8482
US

V. Phone/Fax

Practice location:
  • Phone: 425-314-6992
  • Fax:
Mailing address:
  • Phone: 425-314-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH60170887
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: