Provider Demographics
NPI:1417430661
Name:ANDERSON WENNINGER, SARINA (RDH)
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:
Last Name:ANDERSON WENNINGER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SARINA
Other - Middle Name:
Other - Last Name:WENNINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 3835
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3835
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:1629 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6701
Practice Address - Country:US
Practice Address - Phone:206-548-2964
Practice Address - Fax:206-632-2844
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60310448124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist