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General NPI Number Information
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NPI Number | 1760847347
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Entity Type | Organization
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Legal Business Name | PATRA ALATSIS DMD MS PS
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 4301 S PINE ST STE 231
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City | TACOMA
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State | WA
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Zip | 98409-7205
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Country | US
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Telephone | 253-474-9473
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Fax | 253-474-6457
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Provider Business Mailing Address
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Address Line | 4301 S PINE ST STE 231
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City | TACOMA
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State | WA
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Zip | 98409-7205
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Country | US
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Telephone | 253-474-9473
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Fax | 253-474-6457
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRA V ALATSIS
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Credential | DMD, MS
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Telephone | 253-851-9473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE 60523093
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License Number State | WA
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