Healthcare Provider Details

I. General information

NPI: 1942414065
Provider Name (Legal Business Name): RODERICK W. TATARYN D.D.S., M.S., P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
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

VIII. Authorized Official

Name: DR. RODERICK WILLIAM TATARYN
Title or Position: OWNER-PRESIDENT
Credential: D.D.S., M.S.
Phone: 509-747-7665