Provider Demographics
NPI:1518591817
Name:THIBERT, LEAH BETH (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:BETH
Last Name:THIBERT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:BETH
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 332
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257
Mailing Address - Country:US
Mailing Address - Phone:360-466-3900
Mailing Address - Fax:360-466-7301
Practice Address - Street 1:17395 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257
Practice Address - Country:US
Practice Address - Phone:360-466-3900
Practice Address - Fax:360-466-7301
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60315584124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist