MEDICARE: DR. PATRICIA GALLAHER BENCA DENTIST

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	DE00006344	WA

General Provider Information

NPI Number	:	1932282118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA GALLAHER BENCA DENTIST

Provider Business Mailing Address
First Line	:	200 ANDOVER PARK E STE 4
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2938
Country	:	US
Telephone Number	:	206-575-1173
Fax Number	:	206-575-0759

Provider Business Practice Location Address
First Line	:	200 ANDOVER PARK E STE 4
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2938
Country	:	US
Telephone Number	:	206-575-1173
Fax Number	:	206-575-0759

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/05/2015

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