Provider Demographics
NPI:1689896151
Name:SILLIMAN, JANET MARIE (RDH BA)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:MARIE
Last Name:SILLIMAN
Suffix:
Gender:F
Credentials:RDH BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42001 NE DOBLER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-2626
Mailing Address - Country:US
Mailing Address - Phone:360-263-3562
Mailing Address - Fax:
Practice Address - Street 1:42001 NE DOBLER HILL RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-2626
Practice Address - Country:US
Practice Address - Phone:360-263-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00000846124Q00000X
ORH1250124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5900105Medicaid