Provider Demographics
NPI:1407246531
Name:SALLER, DENISE WOOD (RDH,BA)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:WOOD
Last Name:SALLER
Suffix:
Gender:F
Credentials:RDH,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6548 PUGET BEACH RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-9120
Mailing Address - Country:US
Mailing Address - Phone:360-491-0175
Mailing Address - Fax:
Practice Address - Street 1:6548 PUGET BEACH RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-9120
Practice Address - Country:US
Practice Address - Phone:360-491-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00002315124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADH00002315OtherDENTAL HYGIENE LICENSE