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General NPI Number Information
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NPI Number | 1932463502
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Entity Type | Individual
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Provider Name | MARTIN KRISTIANTO MESSAH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 2709 BICKFORD AVE STE. A
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City | SNOHOMISH
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State | WA
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Zip | 98290-1766
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Country | US
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Telephone | 425-374-8451
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Fax | 425-374-8484
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Provider Business Mailing Address
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Address Line | 23510 44TH PL W
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-4399
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Country | US
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Telephone | 415-215-4857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60343308
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License Number State | WA
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