Healthcare Provider Details

I. General information

NPI: 1467977215
Provider Name (Legal Business Name): ANTHONY BOOKER RDH, DA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE ANTHONY BOOKER RDH, DA

II. Dates (important events)

Enumeration Date: 08/12/2017
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6137 S CUSHMAN AVE
TACOMA WA
98408-2352
US

IV. Provider business mailing address

6137 S CUSHMAN AVE
TACOMA WA
98408-2352
US

V. Phone/Fax

Practice location:
  • Phone: 561-308-6619
  • Fax:
Mailing address:
  • Phone: 561-308-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60802924
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1282
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH60284757
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberD160057846
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: