Provider Demographics
NPI:1598979866
Name:ROWLEY AND RUDER, PLLC
Entity Type:Organization
Organization Name:ROWLEY AND RUDER, PLLC
Other - Org Name:SMALL TO TALL PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:FAADOM
Authorized Official - Phone:360-459-5885
Mailing Address - Street 1:222 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5031
Mailing Address - Country:US
Mailing Address - Phone:360-459-5885
Mailing Address - Fax:
Practice Address - Street 1:222 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6103
Practice Address - Country:US
Practice Address - Phone:360-459-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA122300000XMedicaid