Provider Demographics
NPI:1326639980
Name:KINGSLEY, PAULA RAE
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:RAE
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 S 262ND PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7145
Mailing Address - Country:US
Mailing Address - Phone:253-797-5176
Mailing Address - Fax:253-854-1993
Practice Address - Street 1:4014 S 262ND PL
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7145
Practice Address - Country:US
Practice Address - Phone:253-797-5176
Practice Address - Fax:253-854-1993
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1718124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist