Provider Demographics
NPI:1487756649
Name:MENKE, REX ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:ALLEN
Last Name:MENKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001
Mailing Address - Country:US
Mailing Address - Phone:509-244-3655
Mailing Address - Fax:509-244-9527
Practice Address - Street 1:13326 W 14TH STREET
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001
Practice Address - Country:US
Practice Address - Phone:509-244-3655
Practice Address - Fax:509-244-9527
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist