Healthcare Provider Details

I. General information

NPI: 1376833939
Provider Name (Legal Business Name): LAUREN M VAINIO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 25TH AVE NE SUITE 205
SEATTLE WA
98105
US

IV. Provider business mailing address

4915 25TH AVE NE SUITE 205
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-1600
  • Fax: 206-524-1603
Mailing address:
  • Phone: 206-524-1600
  • Fax: 206-524-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60293875
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: