Provider Demographics
NPI:1326629106
Name:DOSSANTOS, GARY (MS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:DOSSANTOS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 S 152ND ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1111
Mailing Address - Country:US
Mailing Address - Phone:425-650-2004
Mailing Address - Fax:
Practice Address - Street 1:658 S 152ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1111
Practice Address - Country:US
Practice Address - Phone:425-650-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist