Individual
DR. CARRIE ANN TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
605 S COOLIDGE ST, MOSES LAKE, WA 98837-1893
(509) 765-0674
(509) 765-6591
Mailing address
1571 FAIRWAY DR NE, MOSES LAKE, WA 98837-9161
(509) 766-7294
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00009098
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181185
DEPT LABOR & INDUSTRIES
WA
05
—
5040696
—
WA
Enumeration date
12/06/2006
Last updated
05/13/2013
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