Healthcare Provider Details

I. General information

NPI: 1134192982
Provider Name (Legal Business Name): TERRY GAIL DAVIS DH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 W CLEARWATER #109
KENNEWICK WA
99336
US

IV. Provider business mailing address

PO BOX 1323
PASCO WA
99301
US

V. Phone/Fax

Practice location:
  • Phone: 509-374-1243
  • Fax: 509-374-2772
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00006163
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: