Healthcare Provider Details

I. General information

NPI: 1104741032
Provider Name (Legal Business Name): DAVIA ANUHEAOKALALOHONUA KAOPUA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SE EVERETT MALL WAY BLDG D
EVERETT WA
98208-3208
US

IV. Provider business mailing address

9803 23RD AVE SE
EVERETT WA
98208-3861
US

V. Phone/Fax

Practice location:
  • Phone: 425-267-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDENT.DE.70149933
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: