Healthcare Provider Details

I. General information

NPI: 1174059604
Provider Name (Legal Business Name): ROBERTA BYRD-WRIGHT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 12TH AVE S SUITE 401
SEATTLE WA
98144-2712
US

IV. Provider business mailing address

1200 12TH AVE S SUITE 901
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-5850
  • Fax: 206-328-4034
Mailing address:
  • Phone: 206-548-3114
  • Fax: 206-762-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberD2 60156655
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00001697
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: