Provider Demographics
NPI:1164900031
Name:DEWENTER, ALYSSA CATHERINE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:CATHERINE
Last Name:DEWENTER
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 1:3609 173RD CT NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5703
Mailing Address - Country:US
Mailing Address - Phone:425-233-2545
Mailing Address - Fax:
Practice Address - Street 1:12502 MUKILTEO SPEEDWAY STE 108
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5730
Practice Address - Country:US
Practice Address - Phone:425-374-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102931122300000X
WA612850501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist