Provider Demographics
NPI:1326261108
Name:PFEFFER, CARLA LEERAE (RDH)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LEERAE
Last Name:PFEFFER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 785
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-0785
Mailing Address - Country:US
Mailing Address - Phone:509-962-2248
Mailing Address - Fax:
Practice Address - Street 1:1801 E 14TH AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-5127
Practice Address - Country:US
Practice Address - Phone:509-962-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00002636124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5900261Medicaid