Provider Demographics
NPI:1356653067
Name:ALCANTARA, IRMA TANCHOCO (DENTURIST)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:TANCHOCO
Last Name:ALCANTARA
Suffix:
Gender:F
Credentials:DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 ML KING JR WAY SOUTH
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118
Mailing Address - Country:US
Mailing Address - Phone:206-722-8858
Mailing Address - Fax:206-722-0992
Practice Address - Street 1:7101 ML KING JR WAY SOUTH
Practice Address - Street 2:SUITE 211
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118
Practice Address - Country:US
Practice Address - Phone:206-722-8858
Practice Address - Fax:206-722-0992
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000049122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist