Provider Demographics
NPI:1790893501
Name:HAKES, KATHERINE M (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:M
Last Name:HAKES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 W LOWELL RD
Mailing Address - Street 2:STE 130
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9256
Mailing Address - Country:US
Mailing Address - Phone:509-464-3100
Mailing Address - Fax:509-464-3200
Practice Address - Street 1:5011 W LOWELL RD
Practice Address - Street 2:STE 130
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-9256
Practice Address - Country:US
Practice Address - Phone:509-464-3100
Practice Address - Fax:509-464-3200
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000066651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5015383Medicaid