Individual
COLLEEN BOTHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
12 S 8TH ST, YAKIMA, WA 98901-3020
(509) 454-4143
Mailing address
PO BOX 2605, YAKIMA, WA 98907-2605
(509) 454-4143
(509) 454-4115
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE60732007
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/02/2016
Last updated
11/30/2018
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