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General NPI Number Information
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NPI Number | 1942414065
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Entity Type | Organization
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Legal Business Name | RODERICK W. TATARYN D.D.S., M.S., P.S.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2700 S SOUTHEAST BLVD SUITE 201
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City | SPOKANE
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State | WA
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Zip | 99223-4984
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Country | US
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Telephone | 509-747-7665
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Fax | 509-747-0435
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Provider Business Mailing Address
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Address Line | 2700 S SOUTHEAST BLVD SUITE 201
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City | SPOKANE
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State | WA
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Zip | 99223-4984
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Country | US
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Telephone | 509-747-7665
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Fax | 509-747-0435
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Authorized Official
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Title or Position | OWNER-PRESIDENT
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Name | DR. RODERICK WILLIAM TATARYN
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Credential | D.D.S., M.S.
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Telephone | 509-747-7665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 7248
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License Number State | WA
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