Provider Demographics
NPI:1942414065
Name:RODERICK W. TATARYN D.D.S., M.S., P.S.
Entity Type:Organization
Organization Name:RODERICK W. TATARYN D.D.S., M.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TATARYN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:509-747-7665
Mailing Address - Street 1:2700 S SOUTHEAST BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4984
Mailing Address - Country:US
Mailing Address - Phone:509-747-7665
Mailing Address - Fax:509-747-0435
Practice Address - Street 1:2700 S SOUTHEAST BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4984
Practice Address - Country:US
Practice Address - Phone:509-747-7665
Practice Address - Fax:509-747-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA72481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty