Provider Demographics
NPI:1417713199
Name:KUMUDRA T SOE DMD PLLC
Entity Type:Organization
Organization Name:KUMUDRA T SOE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAQUILING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-670-2392
Mailing Address - Street 1:7533 OLYMPIC VIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-5524
Mailing Address - Country:US
Mailing Address - Phone:425-670-2392
Mailing Address - Fax:425-776-8173
Practice Address - Street 1:7533 OLYMPIC VIEW DR STE C
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-5524
Practice Address - Country:US
Practice Address - Phone:425-670-2392
Practice Address - Fax:425-776-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental