Individual
TYLER DOUMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9019 E MISSION AVE, SPOKANE VALLEY OFFICE, SPOKANE, WA 99212
(855) 433-6825
Mailing address
6950 NE CAMPUS WAY, HILLSBORO, OR 97124-5611
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60660643
WA
390200000X
Student in an Organized Health Care Education/Training Program
RR 60559973
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54456158
DENTPIN
WA
Enumeration date
02/10/2016
Last updated
07/13/2016
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