Healthcare Provider Details

I. General information

NPI: 1073789178
Provider Name (Legal Business Name): RICHARD FRANK WEATHERILL III D.D.S., B.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 RIO GRANDE AVE
KENNEWICK WA
99336
US

IV. Provider business mailing address

6335 RIO GRANDE AVE
KENNEWICK WA
99336
US

V. Phone/Fax

Practice location:
  • Phone: 509-579-5830
  • Fax:
Mailing address:
  • Phone: 509-579-5830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number000
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60013025
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: