Healthcare Provider Details

I. General information

NPI: 1770990673
Provider Name (Legal Business Name): ALICIA MARIE WELLS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2014
Last Update Date: 07/18/2014
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

203 N WASHINGTON ST STE 300
SPOKANE WA
99201-0254
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-8200
  • Fax:
Mailing address:
  • Phone: 509-444-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH60486731
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: