Healthcare Provider Details

I. General information

NPI: 1568537256
Provider Name (Legal Business Name): NINA S SVINO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18515 BALLINGER WAY NE
LAKE FOREST PARK WA
98155-2555
US

IV. Provider business mailing address

18515 BALLINGER WAY NE
LAKE FOREST PARK WA
98155-2555
US

V. Phone/Fax

Practice location:
  • Phone: 206-306-0080
  • Fax: 206-306-0222
Mailing address:
  • Phone: 206-306-0080
  • Fax: 206-306-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00009803
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00009803
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: