Provider Demographics
NPI:1619081791
Name:KREGER, KARLA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:MARIE
Last Name:KREGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S CARR RD STE 340
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5840
Mailing Address - Country:US
Mailing Address - Phone:425-277-0204
Mailing Address - Fax:425-204-1340
Practice Address - Street 1:601 S CARR RD STE 340
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5840
Practice Address - Country:US
Practice Address - Phone:425-277-0204
Practice Address - Fax:425-204-1340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA64221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601-334-094-000OtherUBI
WA5009253OtherWDS #