1710029376 NPI number — DR. BECKY VAN GEMERT COOMBS D.D.S.

Table of content: DR. BECKY VAN GEMERT COOMBS D.D.S. (NPI 1710029376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710029376 NPI number — DR. BECKY VAN GEMERT COOMBS D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOMBS
Provider First Name:
BECKY
Provider Middle Name:
VAN GEMERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN GEMERT
Provider Other First Name:
BECKY
Provider Other Middle Name:
COOK
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710029376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 E 29TH AVE
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99203-3957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-315-8500
Provider Business Mailing Address Fax Number:
509-443-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 E 29TH AVE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99203-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-315-8500
Provider Business Practice Location Address Fax Number:
509-443-5456
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  10216 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 10216 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5050166 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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