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NPI Code Detail

MEDICARE: ENDODONTICS OF SOUTHEASTERN WA, PLLC

MEDICARE: ENDODONTICS OF SOUTHEASTERN WA, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223E0200XEndodontics8842WA
21223E0200XEndodontics10481WA
31223E0200XEndodontics7350WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11164582722OTHERJAMES E. LEONARD, DDS
21245390996OTHERLINDA K. BASCOM, DDS
31386692556OTHERROLF M.W. WUERCH, DDS

General Provider Information

NPI Number : 1437313616
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENDODONTICS OF SOUTHEASTERN WA, PLLC
Provider Business Mailing Address
First Line : 10505 W CLEARWATER AVE
Second Line : BLDG. A
City : KENNEWICK
State : WA
Zip : 99336-8613
Country : US
Telephone Number : 509-735-9735
Fax Number : 509-735-9598
Provider Business Practice Location Address
First Line : 10505 W CLEARWATER AVE
Second Line : BLDG. A
City : KENNEWICK
State : WA
Zip : 99336-8613
Country : US
Telephone Number : 509-735-9735
Fax Number : 509-735-9598
Authorized Official
Title or Position : OWNER
Name : DR. LINDA K BASCOM
Credential : DDS
Telephone Number : 509-735-9735
Provider Enumeration Date : 07/16/2008
Last Update Date : 07/16/2008

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1154474229 — MRS. BETH ELDHARDT M.ED
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KENNEWICK, WA
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99336-8613
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1972870426 — MS. AMANDA RAE GARZA MA, LMHC
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99336-8613
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Practice Fax: 509-579-4088

Directions to “ENDODONTICS OF SOUTHEASTERN WA, PLLC ” Practice Location

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