Basic Information
| Provider Information | |||||||||
| NPI: | 1629414362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPENHAVER | ||||||||
| FirstName: | KAMI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 ORONDO AVE STE 1 | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988012800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096623860 | ||||||||
| FaxNumber: | 5096644585 | ||||||||
| Practice Location | |||||||||
| Address1: | 317 E JOHNSON AVE | ||||||||
| Address2: | BOX 2920 | ||||||||
| City: | CHELAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988162920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096826000 | ||||||||
| FaxNumber: | 5096826296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2013 | ||||||||
| LastUpdateDate: | 05/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH00007312 | WA | Y | Dental Providers | Dental Hygienist |
No ID Information.