Provider Demographics
NPI:1245390996
Name:BASCOM, LINDA KATHRYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KATHRYN
Last Name:BASCOM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9667
Mailing Address - Country:US
Mailing Address - Phone:509-735-9735
Mailing Address - Fax:509-735-9598
Practice Address - Street 1:10505 W. CLEARWATER AVE.
Practice Address - Street 2:BUILDING A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338
Practice Address - Country:US
Practice Address - Phone:509-735-9735
Practice Address - Fax:509-735-9598
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA73501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics