Healthcare Provider Details

I. General information

NPI: 1699320143
Provider Name (Legal Business Name): OLGA A HLAVATY-LAPOSA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22060 NE 175TH ST
WOODINVILLE WA
98077-7501
US

IV. Provider business mailing address

22060 NE 175TH ST
WOODINVILLE WA
98077-7501
US

V. Phone/Fax

Practice location:
  • Phone: 206-790-1839
  • Fax:
Mailing address:
  • Phone: 206-790-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60971160
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: