Provider Demographics
NPI:1013039429
Name:SURSELY, PAMELA NANCY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:NANCY
Last Name:SURSELY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12911 120TH AVE NE
Mailing Address - Street 2:SUITE F200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3027
Mailing Address - Country:US
Mailing Address - Phone:425-821-9111
Mailing Address - Fax:425-821-2696
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE F200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-821-9111
Practice Address - Fax:425-821-2696
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60122941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist