Healthcare Provider Details

I. General information

NPI: 1013244839
Provider Name (Legal Business Name): RICHARD JURY RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N. 2ND STREET
SPRINGDALE WA
99173
US

IV. Provider business mailing address

PO BOX 429
SPRINGDALE WA
99173-0429
US

V. Phone/Fax

Practice location:
  • Phone: 509-258-7543
  • Fax: 509-258-7524
Mailing address:
  • Phone: 509-258-7543
  • Fax: 509-258-7524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00004168
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: