Provider Demographics
NPI:1528854072
Name:GOULD, DEBORAH (RDH, BSDH, MED)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:RDH, BSDH, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 GREEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9604
Mailing Address - Country:US
Mailing Address - Phone:509-930-4192
Mailing Address - Fax:
Practice Address - Street 1:1015 S 16TH AVE BLDG 3
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5316
Practice Address - Country:US
Practice Address - Phone:509-574-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00004167124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist