Healthcare Provider Details

I. General information

NPI: 1841727104
Provider Name (Legal Business Name): LALITA ANGKANAWARAPHAN DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 GREENWOOD AVE N
SEATTLE WA
98103
US

IV. Provider business mailing address

4312A EVANSTON AVE N
SEATTLE WA
98103-7209
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-8223
  • Fax:
Mailing address:
  • Phone: 213-503-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code125Q00000X
TaxonomyOral Medicine Dentistry
License NumberDE60814301
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60814301
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: