MEDICARE: MAYA DRANGSHOLT DMD

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	122300000X	Dentist	2901601519	MI
2	122300000X	Dentist	DENT.DE.61327761	WA

General Provider Information

NPI Number	:	1578282067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA DRANGSHOLT DMD

Provider Business Mailing Address
First Line	:	9618 59TH AVE SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2799
Country	:	US
Telephone Number	:	253-584-2124
Fax Number	:

Provider Business Practice Location Address
First Line	:	18310 HIGHWAY 410
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391
Country	:	US
Telephone Number	:	253-863-5188
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	04/08/2026

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