Healthcare Provider Details

I. General information

NPI: 1710077532
Provider Name (Legal Business Name): DOLPHINE ODA BDS, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST B241 HSB
SEATTLE WA
98195-7134
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 357131
SEATTLE WA
98195-7131
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-4440
  • Fax: 206-543-8054
Mailing address:
  • Phone: 206-543-4440
  • Fax: 206-543-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDE00008619
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: