Provider Demographics
NPI:1578536710
Name:SATA, CAMILLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:
Last Name:SATA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 E GREENLAKE DR N
Mailing Address - Street 2:#210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4818
Mailing Address - Country:US
Mailing Address - Phone:206-522-1565
Mailing Address - Fax:
Practice Address - Street 1:7900 E GREENLAKE DR N
Practice Address - Street 2:#210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4818
Practice Address - Country:US
Practice Address - Phone:206-522-1565
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA063891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA768762OtherCONCORDIA PROVIDER ID
WA5024062Medicaid