Healthcare Provider Details

I. General information

NPI: 1386858587
Provider Name (Legal Business Name): RODERICK WILLIAM TATARYN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S SOUTHEAST BLVD SUITE 201
SPOKANE WA
99223-4984
US

IV. Provider business mailing address

2700 S SOUTHEAST BLVD SUITE 201
SPOKANE WA
99223-4984
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-7665
  • Fax: 509-747-0435
Mailing address:
  • Phone: 509-747-7665
  • Fax: 509-747-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7248
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number37293
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD3042
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: