Healthcare Provider Details

I. General information

NPI: 1376501585
Provider Name (Legal Business Name): CHARITY RICHMOND RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 N MAPLE ST
SPOKANE WA
99205-1349
US

IV. Provider business mailing address

3919 N MAPLE ST
SPOKANE WA
99205-1349
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8888
  • Fax: 509-444-7806
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00007023
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: