Provider Demographics
NPI:1629414362
Name:COPENHAVER, KAMI L (RDH)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:L
Last Name:COPENHAVER
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 1:600 ORONDO AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-3860
Mailing Address - Fax:509-664-4585
Practice Address - Street 1:317 E JOHNSON AVE
Practice Address - Street 2:BOX 2920
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-2920
Practice Address - Country:US
Practice Address - Phone:509-682-6000
Practice Address - Fax:509-682-6296
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00007312124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist