Healthcare Provider Details

I. General information

NPI: 1912039348
Provider Name (Legal Business Name): SILVIA LA ROSA D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 S MILDRED ST SUITE 210
TACOMA WA
98465-1627
US

IV. Provider business mailing address

1628 S MILDRED ST SUITE 210
TACOMA WA
98465-1627
US

V. Phone/Fax

Practice location:
  • Phone: 253-565-4700
  • Fax: 253-564-0102
Mailing address:
  • Phone: 253-565-4700
  • Fax: 253-564-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE00009038
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: