Provider Demographics
NPI:1962158949
Name:ROACH, REBEKAH
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:GILREATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HYGIENIST
Mailing Address - Street 1:1125 E IVY AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-3433
Mailing Address - Country:US
Mailing Address - Phone:509-936-1823
Mailing Address - Fax:
Practice Address - Street 1:161 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2906
Practice Address - Country:US
Practice Address - Phone:509-684-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1508820879Medicaid