Individual
REBEKAH ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
161 E 3RD AVE, COLVILLE, WA 99114-2906
(509) 684-1440
Mailing address
1125 E IVY AVE, COLVILLE, WA 99114-3433
(509) 936-1823
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508820879
—
WA
Enumeration date
02/28/2022
Last updated
02/28/2022
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