Healthcare Provider Details

I. General information

NPI: 1023284825
Provider Name (Legal Business Name): BECKY J BLY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 N STEVENS ST
SPOKANE WA
99208-4006
US

IV. Provider business mailing address

6509 N STEVENS ST
SPOKANE WA
99208-4006
US

V. Phone/Fax

Practice location:
  • Phone: 509-465-9973
  • Fax:
Mailing address:
  • Phone: 509-465-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00001259
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: