Healthcare Provider Details

I. General information

NPI: 1194755637
Provider Name (Legal Business Name): ROSARIO PATRICIA PALACIOS D.D.S., M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 116TH AVE NE SUITE 203
BELLEVUE WA
98004-3043
US

IV. Provider business mailing address

1800 116TH AVE NE SUITE 203
BELLEVUE WA
98004-3043
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-7840
  • Fax: 425-452-1537
Mailing address:
  • Phone: 425-688-7840
  • Fax: 425-452-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00010436
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: