Provider Demographics
NPI:1245966449
Name:MORAN, SANDRA (RDH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:9908 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6131
Mailing Address - Country:US
Mailing Address - Phone:509-969-9693
Mailing Address - Fax:
Practice Address - Street 1:5504 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-1627
Practice Address - Country:US
Practice Address - Phone:509-981-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00007033124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist