Provider Demographics
NPI:1194293134
Name:MACKENZIE, ALAYSHA MAE (RDH)
Entity type:Individual
Prefix:MS
First Name:ALAYSHA
Middle Name:MAE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ALAYSHA
Other - Middle Name:MAE
Other - Last Name:GERMAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2592 KWINA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9278
Mailing Address - Country:US
Mailing Address - Phone:360-312-2489
Mailing Address - Fax:360-384-2336
Practice Address - Street 1:2608 KWINA RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9291
Practice Address - Country:US
Practice Address - Phone:360-312-2489
Practice Address - Fax:360-384-2336
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60887073124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist