Provider Demographics
NPI:1811782246
Name:SPICER, KOLBY MARIE (RDH)
Entity type:Individual
Prefix:
First Name:KOLBY
Middle Name:MARIE
Last Name:SPICER
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 SE 192ND AVE UNIT 220
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-6303
Mailing Address - Country:US
Mailing Address - Phone:360-430-0501
Mailing Address - Fax:
Practice Address - Street 1:2311 SE 192ND AVE UNIT 220
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-6303
Practice Address - Country:US
Practice Address - Phone:360-430-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH61192481124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist