Healthcare Provider Details

I. General information

NPI: 1649214925
Provider Name (Legal Business Name): DONNA LOUISE MASSOTH DDS MSD PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAND POINT WAY NE #218
SEATTLE WA
98105-3900
US

IV. Provider business mailing address

4500 SAND POINT WAY NE #218
SEATTLE WA
98105-3900
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-3773
  • Fax: 206-526-7361
Mailing address:
  • Phone: 206-524-3773
  • Fax: 206-526-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00005905
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: