Provider Demographics
NPI:1497024079
Name:STEFANIE K HAMAMOTO DDS PLLC
Entity Type:Organization
Organization Name:STEFANIE K HAMAMOTO DDS PLLC
Other - Org Name:TLC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-351-5381
Mailing Address - Street 1:1323 BOREN AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2527
Mailing Address - Country:US
Mailing Address - Phone:206-351-5381
Mailing Address - Fax:
Practice Address - Street 1:1323 BOREN AVE APT 213
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2527
Practice Address - Country:US
Practice Address - Phone:206-351-5381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601724211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty