MEDICARE: HARRISON WAMAI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.025295	OH

General Provider Information

NPI Number	:	1548778574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRISON WAMAI DDS

Provider Business Mailing Address
First Line	:	16317 SE 9TH ST
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98008-4963
Country	:	US
Telephone Number	:	720-646-9559
Fax Number	:

Provider Business Practice Location Address
First Line	:	6720 FORT DENT WAY STE 210
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2580
Country	:	US
Telephone Number	:	206-433-5595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	09/29/2022

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