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General NPI Number Information
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NPI Number | 1043147416
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Entity Type | Organization
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Legal Business Name | ANDREA M FONNER, DDS
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 1420 3RD ST SE
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City | PUYALLUP
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State | WA
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Zip | 98372-3730
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Country | US
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Telephone | 206-579-5163
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Fax |
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Provider Business Mailing Address
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Address Line | 6947 COAL CREEK PKWY SE # 707
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City | NEWCASTLE
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State | WA
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Zip | 98059-3136
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Country | US
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Telephone | 206-579-5163
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREA FONNER
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Credential | DDS
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Telephone | 206-579-5163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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