Provider Demographics
NPI:1942718747
Name:RAPHAEL, ALLISON MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:FREERKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:7031 LA VISTA DR SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-2154
Mailing Address - Country:US
Mailing Address - Phone:360-261-3747
Mailing Address - Fax:
Practice Address - Street 1:7031 LA VISTA DR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-2154
Practice Address - Country:US
Practice Address - Phone:360-261-3747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60301244124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADH60301244OtherDEPARTMENT OF HEALTH