Provider Demographics
NPI:1689739419
Name:BAXTER, DEBRA A (RDH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:BAXTER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:CLIFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RCH
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:ALLYN
Mailing Address - State:WA
Mailing Address - Zip Code:98524-0593
Mailing Address - Country:US
Mailing Address - Phone:360-275-4069
Mailing Address - Fax:360-275-4069
Practice Address - Street 1:40 E COULTER CREEK RD.
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528
Practice Address - Country:US
Practice Address - Phone:360-275-4069
Practice Address - Fax:360-275-4069
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00004553124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5900980Medicaid