Provider Demographics
NPI:1144410820
Name:MCELDERRY, MARIE L (RDH, BS)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:L
Last Name:MCELDERRY
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 WESTLAKE CT
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-7333
Mailing Address - Country:US
Mailing Address - Phone:509-420-0884
Mailing Address - Fax:
Practice Address - Street 1:4107 WESTLAKE CT
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-7333
Practice Address - Country:US
Practice Address - Phone:509-420-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006047124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist