Provider Demographics
NPI:1164620407
Name:FUNK, PATRICIA ANN (RDH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:FUNK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 172ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3210
Mailing Address - Country:US
Mailing Address - Phone:425-422-7199
Mailing Address - Fax:425-869-7674
Practice Address - Street 1:9015 172ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3210
Practice Address - Country:US
Practice Address - Phone:425-422-7199
Practice Address - Fax:425-869-7674
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00001131124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5902036Medicaid