Provider Demographics
NPI:1083829600
Name:MINAGAWA, SAMUEL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
Last Name:MINAGAWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 STRANDER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2923
Mailing Address - Country:US
Mailing Address - Phone:425-271-5177
Mailing Address - Fax:425-271-0420
Practice Address - Street 1:664 STRANDER BLVD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2923
Practice Address - Country:US
Practice Address - Phone:425-271-5177
Practice Address - Fax:425-271-0420
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000068421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice