Healthcare Provider Details

I. General information

NPI: 1346459864
Provider Name (Legal Business Name): TIA DYER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 WESTERN AVE
SEATTLE WA
98121-1309
US

IV. Provider business mailing address

2430 9TH AVE W
SEATTLE WA
98119-2521
US

V. Phone/Fax

Practice location:
  • Phone: 206-441-2774
  • Fax:
Mailing address:
  • Phone: 206-281-1796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00005437
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: