Healthcare Provider Details

I. General information

NPI: 1326023540
Provider Name (Legal Business Name): KIM LOUISE TAYLOR-FIELDS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KIM LOUISE BEAGLE

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 BEACH DR E
RETSIL WA
98378
US

IV. Provider business mailing address

7435 VANDERBILT LN NE
BREMERTON WA
98311-9444
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-4700
  • Fax: 360-895-4453
Mailing address:
  • Phone: 360-731-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00006611
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: