Healthcare Provider Details

I. General information

NPI: 1649786484
Provider Name (Legal Business Name): TIAH CHRISTINE ESKILDSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 PENNY LN
WALLA WALLA WA
99362-4477
US

IV. Provider business mailing address

1614 SE RED OAK AVE
COLLEGE PLACE WA
99324-1791
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-7030
  • Fax: 509-280-9020
Mailing address:
  • Phone: 509-876-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: