=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477689966
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATS H KRONSTROM DDS, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 9TH AVE MAILBOX 359893
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-731-3189
-----------------------------------------------------
Fax | 206-731-2810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 9TH AVE MAILBOX 359893
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-731-3189
-----------------------------------------------------
Fax | 206-731-2810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DF30000093
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | DF30000093
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------