Healthcare Provider Details

I. General information

NPI: 1043221211
Provider Name (Legal Business Name): JOAN PAVEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOAN LAYTON RDH

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 26TH ST
TACOMA WA
98421-1108
US

IV. Provider business mailing address

101 E 26TH ST
TACOMA WA
98421-1108
US

V. Phone/Fax

Practice location:
  • Phone: 253-597-4550
  • Fax: 253-597-4556
Mailing address:
  • Phone: 253-597-4550
  • Fax: 253-597-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00004908
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: