Provider Demographics
NPI:1821113689
Name:WASHUT, RICHARD P (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:WASHUT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W YAKIMA AVE
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-1337
Mailing Address - Country:US
Mailing Address - Phone:509-697-4666
Mailing Address - Fax:509-697-9575
Practice Address - Street 1:203 W YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942-1337
Practice Address - Country:US
Practice Address - Phone:509-697-4666
Practice Address - Fax:509-697-9575
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA911247323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist