Provider Demographics
NPI:1467977215
Name:BOOKER, ANTHONY (RDH, DA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BOOKER
Suffix:
Gender:M
Credentials:RDH, DA
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:ANTHONY
Other - Last Name:BOOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH, DA
Mailing Address - Street 1:6137 S CUSHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-2352
Mailing Address - Country:US
Mailing Address - Phone:561-308-6619
Mailing Address - Fax:
Practice Address - Street 1:6137 S CUSHMAN AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-2352
Practice Address - Country:US
Practice Address - Phone:561-308-6619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-12
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60802924225700000X
MT1282124Q00000X
WADH60284757124Q00000X
WAD160057846126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant